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Burnett County 7410_Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and n <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. H o W <br /> c W <br /> c <br /> OWNER 9v � G TELEPHONE m <br /> O <br /> O O <br /> ADDRESS �/ / ��C/ A A L) � 't_" � /Le(/ W �--/� S 7-¢..L W:T_ `D Q <br /> EMERGENCY/FIRE NUMBER y �— ROAD NAME A A <br /> LEGAL DESCRIPTION (see tax receipt) '0V 16 X/ S /� 5 3 3 1- 31 6- / <br /> CONTRACTOR 4I�,•; la �v i' b <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ! GARAGE/ACCESSORY STRUCTURE ADDITION N g O <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o < <br /> 0 — <br /> STRUCTURE/ADDITION USE: P ✓ e 1/) 2 <br /> (Home/Cabin;Commercial Business; Bedr om; Deck;etc.) Z <br /> 0 0 <br /> 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infeet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, In 3 <br /> PLOT PLAN D // z `o <br /> H � <br /> m � <br /> ILA <br /> o N <br /> n_ <br /> o <br /> O I <br /> NC <br /> O <br /> 7 <br /> O <br /> N <br /> Z <br /> y <br /> t <br /> N <br /> D NN 'V (nrDDp � <br /> > > n m <br /> �. yii� am <br /> CONDITIONS OF PERMIT: < °i 00o � _ <br /> g m 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F F, ' ? cm T� ? -4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, �+� ' O O <br /> R c i C <br /> g : n , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know[ <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa w m u 4 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have 0 5A o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 8 <br /> A in <br /> SIGN HERE / <br /> w [ a <br /> (signature of owner or b6ilding co a or) (date) -' <br /> o s : <br /> ZONING ADMINISTRATOR - 8 <br /> TOWNSHIP PERMI S MAY BE REQUIRED <br /> p l N N O N O O <br /> 8 $ $ $ $ 888vmi <br />