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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr bed and <br /> ° �o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme sof the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the aws and (T)� <br /> regulations of the State of Wisconsin. e m <br /> m <br /> OWNER Its- S . 89 jon <br /> TELEPHONE <br /> ADDRESS7tOSODLf) 3VEB51tiKrWI • JASp3 <br /> E <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> r <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o �_ <br /> 0 o <br /> SANITARY j� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a < <br /> H � <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> o�� a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) IVa[ <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate No h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c <br /> building .� . <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o N <br /> Z v <br /> PLOT PLANo n <br /> n a <br /> M o <br /> C D <br /> I <br /> O y <br /> 0 <br /> 0 I� <br /> � J <br /> m <br /> O y <br /> N_ <br /> Z /S/ <br /> M <br /> X �'� �'�+ amm <br /> a <br /> CONDITIONS OF PERMIT: Q `B = 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p f O �z : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best t my knowl- o ! C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informs- '1- '• �"m�" T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize tit t this infor- J v g E p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isau a permit. I ? $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providir g in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe on to have m <br /> access to the above described premises at any reasonable time for the purpose of inspection. m , 3 <br /> m $ a <br /> m <br /> SIGN HERE ' <br /> (date) <br /> ZONING ADMINISTRATOR <br /> Of N <br /> NN+NM M.2 T <br /> TOWNSHIP E MRS AV BE REQUIRED SS N N N i5 Rf <br /> 18888888 a) <br />