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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o c c <br /> APPLICATION FOR — LAND USE — PERMITS m o OCJ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 10 $ ,,l <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ t.1-� <br /> regulations of the State of Wisconsin. �, m <br /> OWNER Ina i,t J6'Yi 11/n TELEPHONE Og_68�_3 /� n <br /> ADDRESS O - „�/„ „ r4 1- aft I' /fie 'tifs /G J�/�/ Q i1J <br /> EMERGENCY/FIRE NUMBER ROAD NAME (3 he l <br /> LEGAL DESCRIPTION (see tax receipt) GO u / q O} �,)�, r 5� 4,co 2 a(�S QC Lc yp,QD3 Sfr r$£, <br /> CONTRACTOR c ill L _/ IN <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> / 0 — <br /> STRUCTURE/ADDITION USE: 9� c - Shed y r <br /> o � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> ° V1 <br /> v <br /> m <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 (W),septic tank (ST), and drainfield (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. it separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sitnet and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ON v N <br /> c <br /> PLOT PLAN o n <br /> III 7 o <br /> C ° <br /> I <br /> ,)1 <br /> -/ 3004 <br /> To Wulf- Preps y! T° Ess} P"°►� Zinc <br /> <-- lrnc 7 'ud0{3S 'appp} o <br /> N ~ <br /> Sl�o /3x3fl Shcc� <br /> 98a <br /> 3 ISF+� <br /> � 11 <br /> f rn <br /> CONDITIONS OF PERMIT: o z,: a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m �Q 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P E —to33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" p O <br /> __ : <br /> $ ; Lr C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of ny know[- o <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- E .+m•+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- of <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue it permit. 1 $� $ <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have - O p <br /> access to the above described pn at any reasonable time for the purpose of inspection. <br /> T <br /> m <br /> a <br /> SIGN HERE E a E <br /> gnature of caner r building contractor) I <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N ^�v f5 m <br /> N <br />