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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 l o <br /> APPLICATION FOR — LAND USE — PERMITS 3. :E <br /> d tl <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <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 3 <br /> regulations of the State of Wisconsin. ,n <br /> w � <br /> � <br /> OWNER TELEPHONE(612 � 21 �� E <br /> ADDRESS 1 ) 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) i <br /> XL3c�. 1 �7 . 2b . bg2-nO TO IS Nf,,st <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> `y, n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT '\ SUBDIVISION o 0 <br /> o <br /> STRUCTURE/ADDITION USE: Oikmprnmh Mul-t— o <br /> (Hom /Cabi Commercial Business;Bedroom; Deck;etc.) z p <br /> o � <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 North (N). <br /> r <br /> 2. Show the location of the well (W), septic tank (ST),and drainfield (DF). � <br /> 3. Show dimensions infeet ofthefollowing:(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. Q <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. Q c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITTE. VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In 3 rn <br /> PLOT PLAN NJ gm�Ctn len el1r (QihOn �C�'/icervr� m z a <br /> o n <br /> -1b 1140 <br /> f- C <br /> � IN <br /> 0 <br /> -H <br /> -!® <br /> O <br /> z <br /> I n <br /> f <br /> N <br /> c��r <br /> a N n ea * m <br /> CONDITIONS OF PERMIT: <,m'; Z 8 0 ro T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITH BO DAYS OF PERMIT ISSUANCE. p 5 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r= 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o25 o m <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 i i � 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- r^m'° m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- if g p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $`8 $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am provitling in this ap- d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 $ 9 <br /> A N <br /> 00 <br /> SIGN HE (y, u o owner Tiding contractor) Id e) e.i .8 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP P MITS MAY BE REQUIRED 4 8 <br /> N N m <br />