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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m A o a <br /> APPLICATION FOR - LAND USE - PERMITS 3_ ' <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the O <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 m <br /> m' <br /> OWNER !1 t TELEPHONE7/ j J16 <br /> 5- <br /> fiord � n O <br /> �t/uf au/L ���7• �'8�� o <br /> ADDRESS 1 !'qyS SPI 2/T ZAXC A- Crz C /Z13 &?E/J2E�RJC w-T7 <br /> EMERGENCY/FIRE NUMBER "f I (/ ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Y2 /h <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE __ ADDITION o <br /> I <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 1123 <br /> STRUCTURE/ADDITION USE: <br /> 0 0 l <br /> v <br /> (Home/Cabin;Commercial usiness;Bedroom: Deck;etc-) 0 o <br /> o � <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 (D17. <br /> 3. Show dimensions infeet of thefollowing:(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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'fI a ur <br /> 11 z Q <br /> PLOT PLAN 0 <br /> o <br /> C I <br /> P1 c m <br /> V n <br /> VV ' <br /> t0 <br /> Z <br /> Awo <br /> 5p, '-' s sa erg, <br /> 2 o am m <br /> a—. 6 WQ _ y <br /> CONDITIONS OF PERMIT: : Z L$ m' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o 2)o ' O <br /> o : oO � <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl.- i o; m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o <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. ,n o <br /> D <br /> D <br /> SIGN HERE /10 <br /> a re of o er b Iding contractor , (date) wwenw <br /> n$�P <br /> ZONING ADMINISTRATO n <br /> w <br /> Fn In <br /> TOWmNSHIP PERMITS MAY BE REQUIRED o NNa m00 $00 $0 ?$ $ 1 <br />