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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54472 Office of Zoning Administrator oil <br /> o ' oz <br /> "APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <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 /> i�Zicf��rc� Free, — � r <br /> OWNER LOiS (her( TELEPHONE $ E <br /> ADDRESS o�3011 (fid. 7l 'caS f3u rc� W� jZ fBc�l� P �.° <br /> aagyj 69. Rd a) ( r l2 � w7- <br /> EMERGENCY/FIRE NUMBER . . � ROAD NAME <br /> rn <br /> LEGAL DESCRIPTION (see tax receipt /� / / '1�_ ? _ /�) U) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION /\ o. o <br /> STRUCTUREIADDITION USE: c <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> o e <br /> v <br /> e <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 dralntield (DF). 5 <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -1 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,Contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. C) c y <br /> PLOT PLAN _ `v <br /> � o v <br /> of Z <br /> C9 <br /> suw <br /> � a � <br /> o <br /> G <br /> n <br /> v � <br /> N <br /> v z <br /> G <br /> 90 Lo <br /> CONDITIONS OF PERMIT: v ; <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a ? •2 : .� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. LS:` .`• i G <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the beat of my knowl '• 3 '• C <br /> D p responsible for the detail and accuracy of all informa- <br /> tion y! <br /> edge and ballet it fa true,cornet and complete.1 acknowledge that I am res }}±± ]± ` m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this infor• ` 25 IS C <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 (�Ws,\ g $ <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• i <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have ` <br /> access to the above described premlees at any reasonable time for the purpose of inspection. <br /> SIGN HERE "Irr�� <br /> —IIJ—q4 M ' <br /> (signature owner or building contractor) (date) . <br /> ZONING ADMINISTRATOR J v1l F�c�/IIC "1 <br /> 8; <br /> TOWNSHIP PERMITS MAY BE REQUIRED c �X isi� m <br /> 88888gig vi <br />