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Burnett Couffty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm 0 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m30 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 S <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. w m <br /> c <br /> OWNER Jahr Vy/�LS TELEPHONE <br /> O � <br /> m � <br /> p m <br /> ADDRESS <br /> 5-832 14Y �.� t„J G.r� �✓2.vr �A,J r 5-Lf 8 �J <br /> EMERGENCY/FIRE NUMBER5;3 ROAD NAME (4 y -77 7 <br /> LEGAL DESCRIPTION (see tax receipt) `I <br /> CONTRACTOR D <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_sJ ADDITION _ <br /> � O <br /> SANITARY PRIVY ILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> 0 <br /> P � m r <br /> STRUCTURE/ADDITION USE: ° <br /> g <br /> (Home/Cabin;C mmercial Business;Bedroom;Deck;etc.) o a <br /> 9 <br /> N <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 (DF). 4 <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. <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v rn <br /> c <br /> Z Q <br /> PLOT PLAN ° n <br /> m <br /> C <br /> - I <br /> e) <br /> O <br /> 4 ALL <br /> O � <br /> w <br /> 2 <br /> (Yr/�ry1' <br /> 1 <br /> i; <br /> S Ntll �[n� D DO <br /> O c m n 1 <br /> e = a•� '--- nm am m <br /> a a S m _ <br /> CONDITIONS OF PERMIT: ' < a ro' 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 E a 21 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _< 30 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" : ? u .c°. i i In <br /> O <br /> �; g S � C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o.o m a ' E. 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a m <br /> motion 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 abive described premises at any reasonable time for the purpose of inspection. r <br /> m i v A- i <br /> SIGN HERE o <br /> atu of owne uilding contractor) ( te) ; 8 ? -P <br /> ZONING ADM ISTRA13 LOT "n <br /> TO <br /> TOWNSHIP PERMITS MAY BE REQUIRED S S o m <br /> $ 8888888y <br />