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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 m E o <br /> APPLICATION FOR - LAND USE - PERMITS _ - <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinanoe,Sanitation Code, and with all other applicable County Ordinances and the laws and �. $ <br /> regulations of the State of Wisconsin. <br /> OWNERct"t�.. _/• !t- TELEPHONE f,�_ F257 -o � o m -b F <br /> ADDRESS 33M � �rc <br /> EMERGENCY/FIRE NUMBER L ROAD NAME <br /> LEGAL DESCRIPTION (see tau receipt) 4) /k'I S� �y •� 112 T <br /> CONTRACTOR 3P7- wj r 6, a7,i ! f eje C -m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Irt <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` o <br /> STRUCTURE/ADDITION USE: -bon <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <br /> 3 <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 (NS) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (DIF). <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. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 S, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1111 a N <br /> am . c <br /> PLOT PLAN c <br /> C <br /> m �1 <br /> �{,u/vurl <br /> 0 <br /> _ <br /> o <br /> ,60 <br /> o � <br /> Z <br /> I D <br /> P4 )Q a Icn\ <br /> R $ LoM6'F 5p�vv <br /> CONDITIONS OF PERMIT: a g . Z $is g' <br /> ET <br /> 1. DRIVEWAY MUST MEDRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ y'• E a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �' ' Q C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- Q ? , ' j � <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i « 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 rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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 <br /> plication.I 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. <br /> T <br /> SIGN HERE <br /> (sl at n of ow r building contractor) �l <br /> S « <br /> ZONING ADMINISTRATOR' ' <br /> wg t <br /> - «_ <br /> TOWN8H1 PERMITS MAY BE REQUIRE — 9 I� II a l5• «'Z5 m <br /> 8888* 8 ami <br />