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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator all 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <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 �^ m <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.HA <br /> H <br /> / N � <br /> OWNER 7�(/-('� PI <br /> TELEPHONE /„/ / _�)���� O O <br /> ADDRESS C- <br /> LJAJU��TIXU,L .-�I M�i� ITT i <br /> EMERGENCY//FIRE NUMBER ROAD NAME! 7'17-q,,5 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 _ <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> 0 0 <br /> v <br /> m <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 (yi), septic tank (ST),and drainfield (DF). <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. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. mil o rn <br /> c <br /> PLOT PLAN n o a° <br /> m ^ <br /> 00 <br /> c ( � <br /> a � <br /> U <br /> 6 <br /> � o <br /> 0 <br /> � CU. <br /> n <br /> O y <br /> N �J <br /> ^ 1 <br /> Ij Z <br /> ( D <br /> O c N r>a <br /> 2. Q:m p <br /> m <br /> CONDITIONS OF PERMIT: w. IT <br /> Q C 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !n : t7 m <br /> $: $E ' C <br /> I 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- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `� B <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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.17-1 <br /> m S : <br /> SIGN HERE49 <br /> (sign lure of owner if I o�j�6pto / aG c� <br /> ZONING ADMINISTRATOR <br /> TOWNS IP PERMITS MAY BE REQUIRED N N m <br /> o 000m <br /> I <br /> 000rn <br />