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Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54572 Office of Zoning Administrator 0 7p o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all outer applic County Ordinances and the laws and <br /> cc <br /> regulations of the State of Wisconsin. orj <br /> Is5v 14udsu„ (?d-, C3c4j, rnnl 59CYC <br /> OWNER 96p0 TELEPHONE / $ u O <br /> ADDRESS S l[tu'L Br0 L� Z q,9 97 m m <br /> EMERGENCY/FIRE NUMBERQI/'rI) a - n .•.►�� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> L +03 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-, _ GARAGEIACCESSORY STRUCTURE ADDITION n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION �^' o <br /> = a <br /> STRUCTURE/ADDITION USE: <br /> ° <br /> (Home/Cabin,Commercial Business; Bedroom;Deck;etc.) v <br /> z <br /> o a° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 3 - <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF), r �_ <br /> 3. Show dimensions In fent of the following:(a)building to all lot Tinea,(b)building to center line of road,(c)building o <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 0 <br /> dated by the owner. <br /> NOTE: BUILDINCVSTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 v <br /> PLOT PLAN13 <br /> c <br /> o $ <br /> �d,LSdK t-W.kt � <br /> c <br /> o <br /> Crwia � � <br /> a � � <br /> P6)'h,I IT I S Td <br /> hG <br /> o <br /> m <br /> t7 � <br /> z.x4a Fk� I" <br /> Z <br /> y� <br /> �Ui✓ m C4, <br /> -$ &339 <br /> CONDITIONS OF PERMIT: a g -•o- m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> �.• g's ; <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- ` E T <br /> tion contained In this application(Including any accompanying schedule)and I further declare that I recognize that this infor• <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I `• 8 - <br /> further accept all liability which may be a result of the County of Burnett relying on this information I he providing In this t. I <br /> plication. 1 agree to permit county officials charged with administering county ordinances o other authorized am providing <br /> psreon to have <br /> access to the above described promises at an nable time for the purpose of Inspection. <br /> SIGN HERE <br /> (signature of owner or building contractor) t ` E <br /> « ! <br /> 'ING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED AM 15 ON <br /> 'i� ►� 88888i8�8rmn <br />