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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 a <br /> APPLICATION FOR — LAND USE — PERMITS <br /> • m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements Of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. a m <br /> c o <br /> 15;i'0-6 OWNER /}�► I TELEPHONE <br /> an ! rI h� lYlP, 1 / (,7/����/�'�-7,7r�1�77 m <br /> ADDRESS �� � � �d n n P r La Vit W Jef S Yd'7 0 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) ' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCTURE ADDITION <br /> 00 \V <br /> SANITARY PRIVY FIyL NG/GRADING CAMPING UNIT SUBDIVISION o <br /> C�( �6F aU �c � <br /> a r <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z a <br /> a 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 ofthefollowing:(a) building to all lot linea,(b)building to center line of road,(c)building -q <br /> measurement to the ordinary 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 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A 3 N <br /> �_ Z v <br /> PLOT PLAN A ° <br /> M o <br /> C I o <br /> L) <br /> 0 <br /> II� <br /> N <br /> O <br /> J <br /> n <br /> Z <br /> f <br /> D rn fnV�nr> O1 <br /> 333 <br /> v o <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 5i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- m - r <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- C <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. T <br /> a <br /> 19 <br /> SIGN HE <br /> (signatu f owner or building contractor) ate) . <br /> FlaruU <br /> ZONING ADMINISTRATOR <br /> *9' <br /> TOWNSHIP PERMITS MAY BE REQUIRED o d' {8 15 )5 f <br /> 8888 '8 i <br />