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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator UN I 0 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 undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. <br /> OWNER w I I W1 p C TELEPHONE / -' / 7, <br /> I rI o� YY1raw l J ``'' I[I J o � <br /> ADDRESS m cj Ke- 1{n�\ A.cl\ YNe 65 ` � — <br /> f <br /> ALV <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / <br /> CONTRACTOR d •V e�. ✓ / I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> I - <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: Pan Po rcJ \ ' o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) Z <br /> O 0 <br /> N <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 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. <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. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a to <br /> PLOT PLAN0 n <br /> 955 <br /> n <br /> DF � <br /> 1.i <br /> -I` <br /> O C, <br /> N � <br /> Z <br /> 00 �_ <br /> 1 RoyD <br /> m wa m�>n0 � <br /> e$ <br /> CONDITIONS OF PERMIT: ? m 3.9 ,Z C .0 M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o e 0 j - -� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 21 N <br /> 21 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. T o : - n : p <br /> u : �1 2 : m <br /> E . <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ��E 2i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of III informa- »m>: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- E - if <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. Ii,� o o <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 O 00 <br /> O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 0 <br /> D V A y <br /> i 95 m A . <br /> tin � _o t..0 J y8 € <br /> SIGN MERE 6 <br /> � b" <br /> (signature of owner or building contractor) (dat ) - <br /> ZONING ADMINISTRATOR <br /> -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED y,'o 2 m <br />