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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator0 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The u idersigned 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. a <br /> Faco-(ZN _ <br /> OWNER /ZEd/E $FLEA A-(yLEAJNKR/Ali(�lE TELEPHONE r r <br /> ADDRESSi'1 LJ'r' .i �. _ �, C'� `^ (j" '- <br /> EMERGENCY/FIRE NUMBER -2-753L <br /> UMBERL-' ROAD NAME SiN1p <br /> " � J f �J <br /> J J <br /> LEGAL DESCRIPTION (see tax receipt) Lyoi <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o ^. <br /> N _ <br /> STRUCTURE/ADDITION USE: o = I <br /> (Home/Cabin;Commercial Business; Bedroom: Deck;etc.) Z m <br /> ° o x <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAIN 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 thew II (NI),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center fine of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 to <br /> Mill <br /> c <br /> PLOT PLAN o n <br /> 0 <br /> $ii-L C I <br /> �u�„ttc s M W <br /> 35 <br /> Y � m <br /> sL_ <br /> 435 1 o <br /> i s <br /> I m <br /> w cc UB E <br /> /fou SE f <br /> z I <br /> oil z <br /> �, orComA r <br /> .) S tYu e u,-e o R( C <br /> /aL17Y h <br /> Cd" �Vtl r N C <br /> C—I <br /> I <br /> S ?RUoEQTY ti/AJG- � cM� Saa * m <br /> ---- - <br /> �.a m n <br /> CON m <br /> DITIONS OF PERMIT: v ,z c S (2 C <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o": `z in; -4 <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - p f y^, ` �m 3J <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L7 m <br /> I declare that this application I cludin an accompanyingschedule has been examined b me and to the best of m knowl- <br /> edge <br /> PD C 9 Y 1 Y Y x . <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. i iami m <br /> tion contained in this applicati (including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a Permit. I ; j,IR r, <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. Iagree to permit cou ty officials charged with administering county or 'nances or other authorized person to have O m p <br /> access to the above described Dremises at any reasonable ti m t the purpo f inspection, m '• 3 0 <br /> 01/ <br /> SIGN HERE - d, <br /> (si urs pf owner or but contractor) ate) <br /> ZONING ADMINISTRATOR ,�""r. 9•/ "`"�� r` r QQ x <br /> -;aaa T <br /> aappr Psppea <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N N MIR m <br /> r oob ® oZicm <br /> 000 ® o `4cn <br /> w <br /> 0 <br />