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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator iu m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <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 L ndersigned agrees that all work shall be done in accordance with the requirements of the m o <br /> Burnett CountyLand Use Ordinance,Sanitation Code, and with all other 3 n �. <br /> applicable County Ordinances and the laws and o <br /> regulations of the State of Wisc nsin. w In <br /> c m <br /> m <br /> OWNER O f TELEPHONE J� I � a3 -{a^off C� <br /> ADDRESS g I u) p V l He— <br /> EMERGENCY/FIRE <br /> )EMERGENCY/FIRE NUMBER 1Dl` �) 4� ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p r <br /> 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 00 <br /> o <br /> o <br /> STRUCTURE/ADDITION USE: JTS J 11-_)�L 'I o <br /> (Home/Cabin;Commercial Business;Bedroo ; Deck;etc.) 'Z -' <br /> o <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 m ell (W),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,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must tt signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a rn <br /> PLOT PLAN o <br /> 0 <br /> i I <br /> N <br /> m <br /> Yr .A li y I1rhN^^\� <br /> m g� '-Bo.e 6, <br /> CONDITIONS OF PERMIT: ' Vic° n. Q $ gr� �+ <br /> 1. DRIVEWAY MUST MEET I RIVEWAY WIDTH REOUIREM NTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` 9' : O 2p m <br /> r € 8 1, 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 ! C <br /> edge and belief it is true,corret t 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 I recognize that this infor- B p <br /> mation I am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I r o q - <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 cou ity officials charged with administering county ordinances or other authorized person to have { E O N O3 <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m 3 8 Y <br /> SIGN HERE <br /> �i p t n of owns r budding contractor) i •.° Lc, �� (date) n ; i x : , <br /> ZONING ADMINISTRATOR g <br /> f - 2199 " <br /> TOWNSHIP PERMITS MAY BE REQUIRED MAY I o ZA N a m <br /> 0 0 ai <br /> a <br />