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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S : f c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremerris of the $ <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. �, m <br /> a � <br /> OWNER � TELEPHONE <br /> 7/ 5V 5/ f <br /> ADDRESS .4 Wit (.e 40&1 U)3 syo// <br /> EMERGENCY/FIRE NUMBER3'7/ ROADNAME <br /> LEGAL DESCRIPTION (see tax receipt) G oV AQ'T 6 ,S�- aIle /S uJ. <br /> CONTRACTOR SCI l <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> c1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> 5 < W <br /> STRUCTURE/ADDITION USE: 04�N Q I jag' W(i. Lo! <br /> ;--:f-LO ` t 3 ( mom To- ` o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> ° i <br /> a <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 (VV),septic tank (ST), and dralnfleld (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. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 o O) <br /> PLOT PLA 8k�t * - `c <br /> O O <br /> / N <br /> D <br /> � iZZ� SCJ <br /> 'A 3� <br /> s <br /> 6r6r <br /> 01��C <br /> ;IW f(/ NOD � <br /> Z <br /> } <br /> � r�"�vgin�Q�p5� pg om <br /> CONDITIONS OF PERMIT: Z c 8 g� � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. z o '. V2 <br /> ° E ' N: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c . S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' Q t5 ? m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my k - <br /> now' i E <br /> € el c <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. }g+ § 1 m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I Oc! v ': $4 -8 <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 - <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> 'Tiny ley u <br /> SIGN HERE �+ <br /> (slypstre of owner Iding contractor) (date) �+ <br /> ZONING ADMINISTRATOR <br /> ���"I <br /> ✓/ TOWNSHIP PE MITS MAY BE REQUIRED o ' JAS ON 2 f5 <br /> 8888881 18 <br />