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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( y ) <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby by makes application for a Permit for the work described and w ) <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. o <br /> w m <br /> w � <br /> c <br /> OWNER �y /��N nTELEPHONE ��,5- 3a7- ,f''7/o 0 o f <br /> ADDRESS A�- X .211 <br /> EMERGENCY/FIRE NUMBER ROAD NAME L ouN ry �i�✓E O. CD <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 0 <br /> CONTRACTOR 49 4OuAIZ.4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: 11.4.4,46E o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } <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 in feet 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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR NSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an a y <br /> c <br /> PLOT PLAN o $ <br /> -2,'4-tn cfGSk� <br /> �Y p6 kite <br /> o <br /> 3a _ <br /> v, <br /> tilU� w <br /> �} <br /> /00 T / <br /> T�. <br /> � N (nvmr DD V <br /> CONDITIONS OF PERMIT ? 0 5 C 00 o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E � T� � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = Q : m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. » OC <br /> 8 : : as : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl" g m '� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all nforma. w m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor" m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i8 m <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 ,cNn p <br /> access to the above denabed premises at any reas able time for the purpose of inspection. 3 g <br /> v <br /> M N <br /> N <br /> SIGN HERE r y, <br /> (si a re of ow ne uilding contractor) <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED8 N In <br /> L" c^nc"nc � 09m <br /> — ', 88888888 y <br />