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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (n m c c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby 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 requiremei its of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the aws and �_ $ <br /> regulations of the State of Wisconsin. o <br /> w m <br /> OWNER 1 , 11KC '�n 1T^t 9I'� TELEPHONE >/r_ (�[P'd �/ m O <br /> ADDRESS ) Poo S L'p S'r <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION (see tax receipt) N F-15C Z Ta, o 3,P )v Ji NO L./p'l" <br /> CONTRACTOR 'C-w COK f I-- iy�tr <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ✓ ADDITION p <br /> SANITARY PRIVYo <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> w <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z o <br /> o v <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 Nort I (N). <br /> 2. Show the location of the well (N),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,ii building <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 1I o rn <br /> PLOT PLANZ <br /> � v <br /> o n 11 <br /> � � IICIr�J_rJ <br /> O <br /> IC <br /> 1w , <br /> o <br /> /z K7 0 IN <br /> r jh�k m <br /> w_ <br /> ,sic 5a �y— Skr� <br /> f <br /> Gvu -� Z <br /> 3oKuo�3 ` <br /> /SJr <br /> . /Do <br /> vSn�DD>Oy <br /> CONDITIONS OF PERMIT: 7 s $ :; 33 <br /> ,fi c g g' 33 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN fi0 DAYS OF ERMIT ISSUANCE. o F 0 it <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. it <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : 55 m <br /> � <br /> X ; O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl <br /> : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of at I informs- « ' <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ l m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g'$ <br /> further accept all liability which maybe 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 ' m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (sip tura of ow rIldf ntr tor) (date) <br /> ZONING ADMINISTRATOR $ <br /> N: a <br /> TOWNS PERMITS MAY BE REQUIRED o ( g $ m <br /> � $ $ $8 $ vi <br />