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Burnett Counly 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 — <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w a -� <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 n <br /> regulations of the State of Wisconsin. <br /> U f i <br /> OWNER �Q LZw�.i4,hV� TELEPHONE (pl2 ' i�p� LYjV^L• o m o <br /> ADDRESS aLkS ZG're e,\ A-I� L& <br /> EMERGENCY/FIRE NUMBER �LAa,J ��.1x� ROADNAME PARr, S1' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Sr=L1= <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ;K,— ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o < <br /> r <br /> STRUCTURE/ADDITION USE: STAICZS -FO LA '�L o ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z - r��I <br /> a Y <br /> v <br /> m <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 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 f)-) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 41111 a61111 <br /> �`tn <br /> PLOT PLAN Z p w a <br /> SELr� ^7 A �y <br /> fn <br /> C <br /> a <br /> '" X13 • <br /> w = <br /> s <br /> o <br /> ti <br /> r <br /> m <br /> 11I <br /> �V �l <br /> Z <br /> I <br /> O <br /> R. <br /> a09 <br /> m 'au"aH c= M <br /> CONDITIONS OF PERMIT: o m i ,z C$ Fo S M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e f 0 : �`z i : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =- : i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ! o n i rn <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know l- ^i r m : C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <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 g'$ o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- a <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ry o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 0 , i <br /> a <br /> Nm m P m <br /> SIGN HERE <br /> (signature offer or uild ontraetor) (date) ? 8 <br /> o : xi <br /> ZONING ADMINISTRATOR i g ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED o r i N N m <br /> 0 0 00 $ 0000 o fm/) <br />