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� wo <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> � z< <br /> APPLICATION FOR — LAND USE — PERMITS c _ <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 requiremenof the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I ws and <br /> regulations of the State of Wisconsin. w m <br /> I G 0 <br /> ^ � J p <br /> OWNER ' 1 /!1 Al 5 - /�' O? w a, TELEPHONE 7/S — 6 S 6— 3 3, 9,3 >: <br /> / o <br /> ADDRESS ( o S O L A /1 t cZ L /C 0 a tl) 1)23i()60 <br /> EMERGENCY/FIRE NUMBER / p S^ O ROAD NAME 02 b d , <br /> LEGAL DESCRIPTION (see tau receipt) 3.- :Z e'O <br /> pct y ,tsr 4'ou �v so )`J�l S %2 Sw I ` <br /> CONTRACTOR te <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a <br /> STRUCTURE/ADDITION USE: o = <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <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 Nort4 (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of thefollowing:(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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sign and 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Ili 3 m <br /> c <br /> PLOT PLAN � � \ � � ? n <br /> C <br /> 3 � � y°e �� SO <br /> r-� <br /> / v <br /> r `v <br /> o <br /> m rnv aaov <br /> �c =.� <br /> CONDITIONS OF PERMIT: ^ z: Z c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zo Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. e E w E �,--N• >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. `}. ut : Gt ii m <br /> Q ; : O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- l C <br /> Doi <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of a informs- " «m•+ m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that his infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pare n to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. i 3 <br /> SIGN HERE ^"""" / a E <br /> isure of ow r or building contractor) (date) <br /> n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N'=(a««N"8 m <br /> NN ONtl1 NO m <br /> 8888888 in <br />