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Burnett*County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) T oz <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s � <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 requirems of the 0 <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and t laws and _ <br /> regulations of the State of Wisconsin. m <br /> OWNER 'f)rid � KSsvN TELEPHONE S E <br /> ADDRESS r\ 1 �V g - r � -F C—r <br /> EMERGENCY/FIRE NUMBER ; L t??C) ROAD NAME � �/� .� <br /> LEGAL DESCRIPTION (see tax receipt) A'V/,. 7 f s�' ,�-'3 y T— 3 9 - 16 <br /> CONTRACTOR N/ �n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY�_ PPRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: o 0 <br /> .. (Home/Cabe Commercial Business; Bedroom;Deck;etc.) ' <br /> Z 9 r <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). I <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road, )building O 1�1 <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 M <br /> dated by the owner. O c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN R ISSUED. 03 to <br /> c <br /> PLOT PLAN o n <br /> G < <br /> m o +� <br /> P = <br /> a , <br /> �( <br /> O � <br /> G <br /> J <br /> _ <br /> O D <br /> e <br /> m z <br /> A z <br /> / r <br /> >�o � <br /> a g H g y <br /> CONDITIONS OF PERMIT: a w. Z s g 9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m a.: !'e.2 . : 1 <br /> O E _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> (a; <br /> m <br /> S. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 15 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- o i . L C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy 01 <br /> all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize lh t this infor- m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to iaeu a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providi inthis ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe n to have " <br /> access t0 the ab0 a ribed premises at any reasonable time for the purpose of inspection. P <br /> SIGN HERE N H <br /> (sipnaturo o or it on to (date) � <br /> ZONING Ild BATOR E $ E <br /> L %/ I � ^�' H <br /> TOW NIP PERMI S MAY BE REQUIREID RNNi5 <br /> �, �, m <br /> MU) <br />