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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS ;. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a On <br /> located as shown heroin. 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 <br /> regulations of the State of Wisconsin, v <br /> w m <br /> w m <br /> c <br /> OWNER •f� TELEPHONE <br /> "A <br /> n o <br /> /t\ <br /> ADDRESS f+3 L7 O�Gf' f'1 ✓ /'Y VQ' I'G m I <br /> EMERGENCY/FIRE NUMBER ROAD NAME !i7T�/O <br /> 21) <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> Al <br /> SANITARY PRI <br /> CAMPING CAMPING UNIT SUBDIVISION O <br /> o <. <br /> N <br /> STRUCTURE/ADDITION USE: o <br /> Home/Cabi ommercial Business;Bedroom;Deck;etc.) <br /> Z o <br /> 0 c <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 (W),septic tank (ST),and dralnfield (DF). o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 11 <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 N <br /> PLOT PLAN z `v <br /> o v <br /> f 5. <br /> -0 "j <br /> fl goo xo 8" �6" L) Ilse h� �e Md �ec� a <br /> Yv' uNQ 3bC4 4x3 P) <br /> 20c <br /> j >~o�o w C7 M SE�Lc,c� <br /> 4-�()p <br /> 3 1 x 1, 1p�'J <br /> 40T <br /> and Ner Z <br /> VT <br /> b <br /> .10 <br /> r3 F_ Oft �. <br /> � rIn <br /> CONDITIONS OF PERMIT: <br /> 33 It C <br /> R.M* <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a E :MQ <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. m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- r 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. 1 gr$ $ <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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> r <br /> SIGN HERE__sL1^--'�I :- � i0 g �" ': ` '• : ' <br /> (s*na <br /> pfaol owner or building frac 0 ^ \__ ~ <br /> �r� ` 8 <br /> ZONING ADMINISTRATOR _-- �- ' $ i i f <br /> TOWNSHIP PERMITS MAY BE REQUIRED / 16 <br /> ill ` a" g m <br /> " ca <br /> I _- <br />