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fWC <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 0 a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y —� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the mm <br /> Burnett County Land Use Ordin nce, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n 6' <br /> regulations of the State of Wisc nsin. y o <br /> c <br /> OWNER %Q a TELEPHONE 1_1,`2_SY3_ 27cV <br /> I,- O <br /> ADDRESS�:JJ Q(� �7 f 1 . - S5- �S le <br /> EMERGENCY/FIRE NUMBER � '77 6 D `� SO�l OAD NAME TCo <br /> LEGAL DESCRIPTION (see tax rec ipt) �` 3 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> J — <br /> p� N <br /> STRUCTURE/ADDITION USE: •'Q- o <br /> (Home/Ca n;Commercial Business; Bedroom;Deck;etc-) m <br /> 2 0 <br /> o � <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or tap 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 w MI (W), septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions in feet of I he following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinaiy high water mark of lake,stream, or river. <br /> 4. If separate plans are submil ted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> N E: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 3 rn <br /> PL PLAN "' o a <br /> / M <br /> 2T'l m <br /> s <br /> s� 4 O <br /> si <br /> 0 <br /> 0 <br /> FY <br /> r <br /> z� N a Z <br /> 1 X <br /> c�oNimD aOm <br /> CONDITIONS OF PERMIT: o :5 C �, 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m 0 zmZ ' <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F -N ' M <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' 252 . i rn <br /> I declare that this application(in luding any accompanying schedule)has been examined by me and to the best of my knowl- o ai C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- H y M <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- i 8 B m <br /> mation I am providing will be ri lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit coun y officials charged with administering county ordinances or other authorized person to have N <br /> ONO: <br /> access to the above described I remises at any reasonable time for the purpose of inspection. m o m <br /> SIGN HERE ` ` '0 <br /> (ai jaturof owner or ng contractor) " lrtate) � " xX <br /> ZONING ADMINISTRATOR �A ' S <br /> IJ.74 . <br /> TOWNSHIP PERMITS MAY BE REQUIRE o U,� N <br /> � � m <br /> 0 <br /> I--- —. 0 0 o N <br />