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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) o o f� <br /> APPLICATION FOR - LAND USE - PERMITS11 <br /> a ° <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 requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. - v m <br /> NiPfS - � iZ"7k1— i6� / <br /> r' m <br /> OWNER Y. TELEPHONE ),55— 3 <br /> /� J�V �jVVV \�1fj j�/�-ten/ _, / <br /> ADDRESS 3 b / 1, fes. <br /> EMERGENCY/FIRE NUMBER 3 D ROAD NAME L,n oj LA k-r , i2 <br /> LEGAL DESCRIPTION (see tax receipt) OCHS 1 <br /> 1 "YY i <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X _ ADDITION p <br /> n � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> o < <br /> STRUCTURE/ADDITION USE: 'S—r- VP0Z-N 6'L 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <br /> m <br /> 3 <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 draintleld (DF). <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. <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. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STA FQQ ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A a m <br /> Z c <br /> PLOT PLAN ° <br /> / N <br /> rd�.� <br /> V <br /> � 1 <br /> 1 �5 ° <br /> 1 <br /> R. <br /> m <br /> 4 9 � <br /> 1 <br /> i <br /> i f <br /> Ile! <br /> S3 - o <br /> CONDITIONS OF PERMIT: v 3:: Z c 8 g <br /> O <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. a ! `z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> i <br /> C'iE : E C <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> motion 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 descripromises at any reasonable time for the purpose of inspection. <br /> SIGN MERE <br /> signature of ow r or building contractor) (date) <br /> r [ ` E 25 '• <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE ITS MAY BE REQUIRED o ' t5• BI $ m 11 <br /> 8888 8, 8 4mi <br />