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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d - �0 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 Q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the mm <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. o <br /> N d <br /> p p m 0 L/ Q <br /> OWNER /16 G YT7 /l IJ 6 / A SOA TELEPHONE 9 <br /> 0 m <br /> ADDRESS <br /> Z9- r/ 12Aye So ,t'i A --/e ).i Nl N SSSyt \ <br /> EMERGENCY/FIRE NUMBER ROAD NAME i uy <br /> ' -✓}v) <br /> LEGAL DESCRIPTION (see tax receipt) d <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> M <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o M <br /> ( (� o 0 <br /> STRUCTURE/ADDITION USE: t�pJ �� I 'l -r<Y)C�P 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Decklatc Z tJ <br /> o 0 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 /> 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. 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. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a v, <br /> PLOT PLAN Z <br /> A o n <br /> 0 <br /> set cfvk C� M y <br /> U) <br /> I <br /> N <br /> d <br /> / R. <br /> R. <br /> � �tlu� a�Icw <br /> 2 <br /> J L aC! �SSoU �lur�� C I�Nt <br /> 2 00 Z <br /> x <br /> D tor (n � .0 DDm o c . m m i n 7 m <br /> a m <br /> CONDITIONS OF PERMIT $ < z C o 0. 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F F E T� <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. \ c O <br /> t� so C <br /> w g : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- '_o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. . . m <br /> n m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I �✓ : m <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 <br /> 'n <br /> is 0 <br /> SIGN HEREr^Z-p vi, : ci <br /> (signs re f owner or build' g contractor) —_" ` (date) <br /> v : x : <br /> ZONING ADMINISTRATORF-Q <br /> H: <br /> TOWNSHIP PERMITS MAY BE REOUI ED JUL . g19e gory) <br /> n no noo � m <br /> U` ggggggggN <br />