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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3' <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. y m <br /> w m <br /> m <br /> G o <br /> OWNER TELEPHONE <br /> C a I' <br /> ADDRESS a G�a O �G y,$"C Owe a Tru, ltv agI!V' <br /> J— <br /> EMERGENCY/FIRE NUMBER 1;`Cy ROAD NAME I'7 vMS u- , LK. 1 l'�rr lwLy -J ee <br /> l j - <br /> LEGAL DESCRIPTION (see tax receipt) Se S S, 'r d <br /> CONTRACTOR 't <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> �/ n Ll <br /> SANITARY /1 PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION a ° �\\ <br /> m r <br /> 0 <br /> STRUCTURE/ADDITION USE: ° <br /> o Cabin;Commercial Business; Bedroom; Deck;etc.) Z a <br /> 1 <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 drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(a) bulldingto all lot lines,(b)buildingto 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 2 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I 3 rn <br /> c <br /> Z c <br /> PLOT PLAN //�� ° a <br /> IOT <br /> a <br /> m <br /> )`'( Qom) Z <br /> 10 <br /> o <br /> Y <br /> ° <br /> O \ � <br /> v <br /> L <br /> Z <br /> I � <br /> m inc.. 9 0 aO rn <br /> W2. Q: <br /> D-.. � w <br /> CONDITIONS OF PERMIT: <,h' Z ?m T+ <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F '1* <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =r= M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U1 : � m <br /> i: e <br /> gi <br /> i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : Oki <br /> : : <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- : "m " m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infer- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0(8 0 <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- N <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O u, p <br /> access to the a ve described premises at any reasonable time for the purpose of inspection. 3 g ; <br /> T <br /> � m n w <br /> -7- 13-r? <br /> SIGN HERE r" E <br /> (signature of owner or buil g c tract (date) Ni �,, <br /> _ LU . o <br /> i i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP ERMITS MAY BE REQUIREDo "d'NM <br /> Joe 0 0000 <br />