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Burnett County 744 Jo. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> OPLICATION FOR — LAND USE — PERMITS 3 <br /> 70 THE ZONING ADh,.NISTRATOR:The undersigned hereby makes application for a Permit for the work described and e <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 Cand Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. = o <br /> x d <br /> OWNER WMr,7 /`-0V�l��/q�Jf IS� l.-LlA/.tIJ c O <br /> VvL c <br /> TELEPHONE <br /> y� /A' I (/n�J � I /�',/ m <br /> ADDRESS p4l V Al<SSe�tu. �I U !I& VI I� 4;I bGA�G i W �— ^ SYy/t/5/7 0 <br /> EMERGENCY/FIRE NUMBER 1/ 7 v�n O v ROAD NAME �ss• 1171 /�.CL ` <br /> or / b <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> CONTRACTOR fN�.l.1 AG I lei r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY P FILLING/GRADING CAMPING UNIT SUBDIVISION n O <br /> o <br /> ` o <br /> STRUCTURE/ADDITIO _ L42 d) ug ft.' 51&6 <br /> o 3 <br /> (Horn Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <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 drainfieid (DF). o <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. 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 ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ur <br /> PLOT PLAN spo- o g + <br /> Ot <br /> M o <br /> cl <br /> m Ul <br /> ) <br /> d <br /> i <br /> m <br /> -rA 2 <br /> J�t)'� OND <br /> Z <br /> o c m 0 o a IONS OF PERMIT: �Q.r.* 7¢ o• D a m a �9: 00 0.DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DA OF PERMIT ISSUANC � o F � :: ; T� ` � � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED AL G _ I m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SP IFICALL 4) O <br /> g c : <br /> I declare that this application(including any accompanying schedule)has been examined by a best of my knowl- 6- <br /> edge i m `� a <br /> m <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- Fn m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> w a $ <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O 0 O <br /> access to the abov described rem' es at any reasonable time for the purpose of inspection. 3 8 2 <br /> A a i <br /> 'J�"' R O A <br /> SIGN HERE � �[A1�MY' <br /> (signature of owner or but t _g c`ontracto�r�1 (date <br /> o : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIREDN N N N+�+ m <br /> o <br /> vl fnom o 8 m <br /> 888888 $ $ rmn <br />