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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'aa o <br /> APPLICATION FOR - LAND USE - PERMITS 3. 0 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 GO <br /> regulations of the State of Wisconsin. - <br /> m d <br /> N m <br /> C <br /> OWNER TELEPHONE <br /> ADDRESS W7 �, } <br /> "13 / 7 r2 l�Cve (E;ro ) l U_/(/I wQ Q `)K1D, xnA s �IFGN, /ll <br /> EMERGENCY/FIRE NUMBER ROAD NAME �1 <br /> (_LJ H f I <br /> LEGAL DESCRIPTION (see tax receipt) StzC ^7 —T" Zb R /(o Lo �Ut [7- /[/7 <br /> r,vtrt <br /> CONTRACTOR r 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION p : <br /> M L� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 <br /> o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial usiness;Bedroom; Deck;etc.) Z 0 <br /> 0 0 <br /> a <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 drainfieid (DF). <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 O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIF TION BEFORE A PERMIT CAN BE ISSUED. 71 c N <br /> PILQ / o a <br /> fjQPLAN C4 <br /> ®t/W <br /> /nnp/[,n'l fj y <br /> I/ ' 1 <br /> � I <br /> f � <br /> l <br /> 1 <br /> 00 <br /> 3z <br /> 31 <br /> '\ Z 0 <br /> r v D <br /> CV <br /> G <br /> CONDITIONS OF PERMITQ c � no 5, � <br /> . DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE._- e m o <br /> ION IS RIESTRICTED AL G SHORELINE. ]7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. T : 6 o = m <br /> ji <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : o : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «ry.� m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I oo <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 O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 0 <br /> ORE.m <br /> m <br /> N ° o <br /> SIGN HERE z_� _ �� t '-7 - <br /> e, <br /> (signature of ow ar u' I contra <br /> L o x: <br /> ZONING ADMINISTRATOR _ S <br /> I <br /> • ufnu�u�n � �1 <br /> TO NSHIP PERMITS MAY BE REOUI <br /> 9 00000 <br />