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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator V� I m 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 H <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 <br /> regulations of the State of Wisconsin. = o <br /> N N <br /> w <br /> C <br /> m <br /> OWNER Q L Q � Y ' �j TELEPHONE V Z 9J� O <br /> ADDRESS 6-,k 961 d 151 / S <br /> EMERGENCY/FIRE NUMBER ROAD NAME -1.. I L� I 1 O <br /> LEGAL DESCRIPTION (see tax receipt) ��(•l� /\Or <br /> CONTRACTOR 62 & „nCZr <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE _ ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING UNIT SUBDIVISION <br /> SUBDIVISION <br /> o ;- <br /> �) <br /> STRUCTURE/ADDITION USE: Ode/ 0 0 1v <br /> (Home/Cabin; Commercial Business;Bedr m; Deck;etc.) v <br /> Zo <br /> P v <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). 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 -0 <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 2 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> PLOT PLAN Z <br /> p n <br /> o <br /> y I <br /> - Y64 <br /> i <br /> o <br /> o <br /> N <br /> O ^� <br /> Y - o <br /> ar <br /> u <br /> z� <br /> . w I <br /> 13 AV <br /> D <br /> - c <br /> CONDITIONS OF PERMIT i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 2 io'0 : Q 'i <br /> o F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o . BO <br /> 2 <br /> 1 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 informa- m In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ <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 b <br /> T 3 0 <br /> nt m N <br /> m <br /> SIGN HERE <br /> (signature o ner or building contractor) (date) «' ' <br /> ZONING ADMINISTRATOR ` $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N N N «« m <br /> N N W N N N V <br /> O N <br />