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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0r ( m o' o <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 o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem ants of the m m <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. o <br /> OWNER [/,(� L/�J '7' TELEPH (,1,2_ / /) n AE <br /> O <br /> -V 0gyJ � <br /> ADDRESS dr CI <br /> EMERGENCY/FIRE NUMBER /J ROAD NAME � A� <br /> 1 <br /> J <br /> LEGAL DESCRIPTION (see tax receipt) <br /> :!rcd77-1'e13'T[ <br /> .� �/77-1'e13 _ <br /> CONTRACTOR A10 4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE A-' ADDITION p <br /> n G) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: r C: g <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z m <br /> 0 0 1. <br /> a r <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 No h (N). <br /> 2. Show the location of the well (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,( )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 be 8 Igned and 2 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 <br /> 0 0 c N <br /> PLOT PLANon New (q Cl y z `o <br /> p n <br /> y M ti_1 <br /> / IJP) r4 l F A /� C r w L <br /> I <br /> 0 <br /> I <br /> � N <br /> ' R m <br /> J\ o <br /> _ <br /> 95' <br /> h <br /> is <br /> O 1 <br /> y <br /> �0 .01 <br /> dp <br /> Z <br /> o t�' )arj°s� G2 111 <br /> ca �aa * m <br /> m D�� ayQ= 31 <br /> CONDITIONS OF PERMIT: a -: � c, <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. z m o <br /> _ yam: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 2 : fn <br /> B <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informa- ImIm <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor. . . B m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o°di <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 per on to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> _ m <br /> N <br /> SIGN HERE <br /> (sign ur o owner ilding contractor) <br /> 1 <br /> ZONING ADMINISTRATOR Y\ xxk <br /> dpi "8 ' % i <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N�'°"° <br /> out utut <br /> � 000 �o ym <br /> 0 <br />