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Burrett County 7410 Co. d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator V ( o <br /> F <br /> APPLICATION FOR — LAND USE — PERMITS a — <br /> s J <br /> TO THE ZONING ADMINISTRA R:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The ui idersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordirm nce,Sanitation Code,and with all other applicable County Ordinances and the laws and $ <br /> regulations of the State of Wisc nsin. H m <br /> u m <br /> c <br /> m <br /> OWNER t TELEPHONE o- <br /> m <br /> ADDRESS d ' m !^ <br /> EMERGENCY/FIRE NUMBER ROAD NAME ( � � <br /> U4w� <br /> LEGAL DESCRIPTION (see tax rec ipt) Al LA-1 57 2- 1. N.. if 17 <br /> CONTRACTOR <br /> io <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> I 0 <br /> f y <br /> ay �y w' a ' s• s <br /> STRUCTURE/ADDITION USE: v <br /> (Home/Cabin;Commercial Busi ess;Be (com; Deck;etc.) Z v <br /> ° 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAII 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 ill (W),septic tank (ST), and drainfteld (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 ordinal high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '7] 3 w <br /> PLOT PLAN ' ? c <br /> o a <br /> � o <br /> ._ _ ..... ... C I <br /> SU <br /> i LY SUN rlo'I/ C- I ut <br /> /( L <br /> 1 0. <br /> 0 <br /> Gj <br /> z <br /> I D <br /> I <br /> S I� <br /> ' - a <br /> tIn, <br /> 0 <br /> ELI� <br /> CONDITIONS OF PERMIT: '^ < Z c g Ic <br /> 1. DRIVEWAY MUST MEET CRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E B : :ilz ' "t <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - = 9 <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r �' ` n mm <br /> e ` C <br /> I declare that this application(I icluding any accompanying schedule)has been examined by me and to the best of my knowl- : o : <br /> edge and belief it is true,torr t 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 that this infor- <br /> mation I am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i $ <br /> further accept all liability whict may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have - <br /> access to the above des ribed premises at any reasonable time for the purpose of Inspection. r $ <br /> SIGN HERE <br /> (s fnat (a of owns tiding cgntractor) (date) <br /> ZONING ADMINISTRATOR <br /> NM+�NN N+� -nTOWNSHIP PE fTS MAY BE REOUIREO o a S4 N 9'a 8 m <br /> 8 8 8 8 8 81818 ai <br />