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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m ° <br /> g by application for a Permit for the work described and � c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremems of the m <br /> Burnett County Land 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 /> m m <br /> w <br /> OWNER _7 n� Q J , r TELEPHONE <br /> ADDRESS /=Lb��/ 7 o�F� lr: ' Y �J�C-e> e•✓ (,,/i Sl d"� m <br /> EMERGENCY//FIRE NUMBER !1 W ROAD NAME �,r\ <br /> LEGAL DESCRIPTION (see tax receipt) �^^ <br /> �J <br /> CONTRACTOR /I // <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> o = <br /> STRUCTURE/ADDITION USE: am 1 Ii [` K'ilm <br /> (Home/Cabin;Commercitil Business;Bedroom;Deck;etc.) <br /> Z o <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 (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). I i; <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. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION.BEFORE A PERMIT CAN BE ISSUED. 1A s q O <br /> c T <br /> PLOT PLAN p�y� v o a <br /> rn 0. Z <br /> C , <br /> a <br /> m <br /> p� ET <br /> o <br /> l6 <br /> IF <br /> /Y f A 3 c 0 9� <br /> ,vf-4JI^ O y <br /> z <br /> z <br /> I � <br /> !� <br /> � ar <br /> D o c m 0 a m <br /> = g� > > m <br /> CONDITIONS OF PERMIT: c R <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Fs. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : O O <br /> 'm C <br /> g [ a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl" o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <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 relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 $ <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. I agree to permit county officials charged with administering county ordinances or other authorized person to have O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m a n <br /> � m <br /> SIGN HERE <br /> (signature o w er ild' actor♦ [//( ate) o s <br /> ZONING ADMINISTRATOR $ ' <br /> T NSHIP PERMITS MAY BE REQUIRED N `= <br /> (� T <br /> N N O N O O O m <br /> $ $ 8888 $ rml� <br />