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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o o <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> m ° <br /> TO THEZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v , <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. o <br /> 7 <br /> OWNER ,BEdOE�LR J07�/U,$O/✓ TELEPHONE �/� y��S G�U o v j O <br /> ADDRESSGRgatS4v/2 w <br /> EMERGENCY/FIRE NUMBER c��'/I ROAD NAMEY <br /> ^ ,J /� GQ/tSd^ t^ C�1 <br /> LEGAL DESCRIPTION (see tax receipt) kd— d_l f ( �.,���j 06,,45 ,lam <br /> CONTRACTOR I'Tµ ///"' <br /> J n^. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p 1LJ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION oo It. <br /> STRUCTURE/ADDITION USE: ��rr'f7Le Int O U <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> ° <br /> 3 � <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 (DIF). o <br /> 3. Show dimensions In feet of thefollowing:(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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. YI a rn <br /> PLOT PLAN z <br /> C ' <br /> M r <br /> In Q 0 <br /> W <br /> Cs <br /> 1-1 c ° <br /> a�ouy yXac N <br /> GU. 6Gi1. � 6'1 CCVoU� � O¢ <br /> rd <br /> y <br /> �J l <br /> o c m m o a : m <br /> 0 o n o m <br /> m am a: = 33 <br /> CONDITIONS OF PERMIT: v A g : ,z go 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F - r� <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. <br /> mom ; C <br /> g a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m : 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� : w m <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. I 8 '? <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 0 . p <br /> access to the above described premises at any r sonable time for the purpose of inspection. m <br /> m 3 H : <br /> m m <br /> SIGN HERE <br /> (signa of wrier or b contractor) (date) <br /> I <br /> I V : J <br /> ZONING ADMINISTRATOR "tet 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �N N N O N O ° m <br /> 888989 9UM) <br />