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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N ro l OZ <br /> E <br /> APPLICATION FOR — LAND USE — PERMITS Y o <br /> TO THE Z.9NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w r <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s 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. w R <br /> OWNERTEL CJ CJ�/<L ��� I\T� l P N - ( Z_'7(0-cl S7 p ^ m <br /> ADDRESS f/ Wh - E'-d.� L -- ° 1 ti <br /> EMERGENCY/FIRE NUMBER 37/ ROAD NAME vZ�bil ^^ , <br /> V' ) <br /> LEGAL DESCRIPTION (see tax receipt) C <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> STRUCTURE/ADDITION USE: S HED <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o 0 <br /> 0 <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 Nort I (N). r <br /> 2. Show the location of the well (VI),septic tank (ST),and drainfleld (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 X <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. a N <br /> 1A Z c <br /> PLOT PLAN ° <br /> LA. <br /> C I <br /> M <br /> I <br /> Q N <br /> R <br /> a <br /> 0 <br /> 0 <br /> m <br /> I7 y <br /> r I <br /> Z <br /> ( D <br /> r <br /> m <br /> gg <br /> XI <br /> CONDITIONS OF PERMIT: �zCgg <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> o Ems m: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^��, 33C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- E E E e <br /> wipe and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th t this infor- B a p <br /> Mellon I 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 t County of Burnett relying on this information I am providinin this ap- <br /> plication.I agree to permit county officials chs ged ith administering county oMinances or other authorized person to have <br /> access to the above perfbed premises le time for the purpose of inspection. mT <br /> SIGN HERE <br /> Ign of wner or Ino contractor) <br /> i <br /> ZONING ADMINISTRATOR ` g <br /> AUG — 11994 »»"»»«" <br /> TOWNSHIP PERMITS MAY BE REQUIRED 'o )' 8-los g',!IR'8 m <br /> 888888188 rmn <br />