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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Administrator U) m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ ' <br /> d o <br /> TO THE"ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m �� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 c - <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 <br /> o <br /> cm <br /> n O <br /> )c4wx�'- ELEPHONEOWNER 2 " v <br /> O I ' <br /> m m <br /> ADDRESS /D �� �n /G'O._ SC2•S�� y /� �SSO�T - m �. J. <br /> I rvI <br /> EMERGENCY/FIRE NUMBER 50 30)(/ ROAD NAME '�//�GJj �/l yyt J <br /> X <br /> LEGAL DESCRIPTION see tax receipt) �o% Sr / o � � �!/� t35 /� , <br /> f. <br /> CONTRACTOR rJ ll�� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p }� <br /> n L1 j <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <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). <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o rn <br /> c <br /> PLOT PLAN n o a I-e- <br /> l J M J� <br /> C ' <br /> 44 <br /> -( 6 <br /> r <br /> Z ��� i� o <br /> J <br /> N { � <br /> O l "i <br /> Ce�di�tatirO��ten,Y-�' — <br /> I <br /> i <br /> -- D T_ 0 rn vr�nDDD m <br /> L-0 O c o a f <br /> m 92L� O.NCm -A <br /> CONDITIONS OF PERMIT: ? 2 y.; Z C .0 ins, r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 o �� i 11 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E =ti M <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 6 2 : m <br /> aOff i ? C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 2i m B <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- u y H m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- I g p <br /> mation 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 whigrmay be a result of the County of Burnett relying on this information I am providing in .this ap- <br /> plication.I agree to permit,96unty officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above de . . . <br /> 'rib'efilf remises at any re onable me for the purpose of inspection. <br /> 0 m A 0 <br /> SIGN HERE ` <br /> (sign ur of owner ding c rector) (— G 77 ` <br /> ZONING A ` INISTRATOR <br /> r wp;w�'Fn wFn In <br /> TOWNSHIP PERMITS MAY BE REOUIRED �f APS ' g __ o U N N m <br /> �— 98 o 0 0 60 (A <br /> _ vd <br /> Y <br /> V <br />