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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator J m ' o o <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> c <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w t� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and c <br /> regulations of the State of Wisconsin. �, m <br /> CSB) 36 a-5 997 #oMf_ c = o <br /> OWNERy'r-t.0e + I ye,C ✓� ( 5rER TELEPHONE g6j 766/ G07f�} -moo <br /> ADDRESS PL33 _f,_0 &1b tA1` C FLOI ! I <br /> EMERGENCY/FIRE NUMBER ^�,//� ROAD NAME <br /> oS oH-�1 g'b(`iF 2D <br /> LEGAL DESCRIPTION (see tax receipt) <br /> auJ 1-S4oFAW 1-i{SEctioi✓3 7- 34� <br /> CONTRACTOR SF_L F <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE L/� ADDITION p <br /> SANITARY PRIWo <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: ��' (� 4 r aL) / m <br /> o' <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <br /> m <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 dreinfield (DF). 5 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to 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 M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a rn <br /> PLOT P N �O Td E 11 Z `o <br /> 4 <br /> S�° 1 m 00k <br /> m <br /> cc, l\Dr <br /> r Q <br /> J, <br /> 1Ir03 9' `1 <br /> ( ran <br /> / La <br /> -rW K t- <br /> 0'l5' � Z <br /> 60� B ai' qo <br /> p o c m m o n m <br /> CONDITIONS OF PERMIT: ^"` f ro m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT SSUANCE. o F ? _U ? � 3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ =� m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' 2 O <br /> g : <br /> m c C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. g <br /> M A <br /> SIGN HERE <br /> (signature of owner r bu' in tractor) V (dot <br /> o x : <br /> ZONING ADMINISTRATOR �� S <br /> TOW SHIP PERMITS MAY BE REQUIRED <br /> ut fno pioo , In <br /> g8gggggfmA <br />