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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE BONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and .2 <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 3 0 <br /> regulations of the State of Wisconsin. y <br /> w � <br /> c <br /> OWNER SOq�C�jN GL,E,N ROKtNCE TELEPHONE n — ' E <br /> O <br /> ADDRESS3115 Awl W 1"ii£Dt Ric. r U ZS1 / � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> _ n <br /> CONTRACTOR , <br /> TYPE OF PRMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p -� <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION - o <br /> o < <br /> w <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Co mercial Business; Bedroom;Deck;etc.) Z T <br /> 0 0 <br /> v <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 dralnfield (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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M 3j <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> PLOT PLAN 0 Q <br /> o a <br /> m o <br /> C <br /> p�pca�o " r <br /> I <br /> N � <br /> Ul <br /> � J <br /> w <br /> » IO <br /> 2 <br /> me�aNi r>a� 'D <br /> a D � R Q y Q m MM <br /> CONDITIONS OF PERMIT: y .z 6 3 ro E <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ 0: :i4`4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i i =m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : E 62 m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the bast of my knowl- o m C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- `^m a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <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 0" p <br /> access to the above described premises at any reasonable time for the purpose of inspection. ; ; v o 0 <br /> m b A w <br /> FRE .. • —x_'11 w w . <br /> (sr at4,eof ow building contractoq �i � ' r Idale) <br /> SISTRATOR <br /> rna - ar,xsT <br /> TOWNSHIP PERMITS MAY BE REQUIRED i� o uN b N m <br /> moo 'o <br /> m <br /> 000f/1 <br />