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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 C Z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 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 Stale of Wisconsin. m m <br /> m <br /> OWNER TELEPHONE n r1,i £O <br /> PON SC m <br /> ADDRESS '3OnO U4Cls I_0 _]\ ' LANG i, MNi . - 5 `-13y m n <br /> EMERGENCY/FIRE NUMBER 2uu v Q (�S ROAD NAME O V Ej4AND -FK. <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> 1, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> Q <br /> SANITARYPRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 'C. <br /> r <br /> V , <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> m (' <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 drainfield (DF). <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. 0 <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. 02 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 y <br /> PLOT PLAN Z v <br /> o n <br /> 5 <br /> fA o` <br /> C I ° <br /> (A <br /> s <br /> IN <br /> m <br /> I� <br /> m <br /> j) �1 <br /> 1 <br /> Z <br /> J jl <br /> 1/ 1r <br /> V I <br /> J � <br /> 9 wCo cvc to DDp <br /> CONDITIONS OF PERMIT: �^ Z•i •Z a o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. cm' o: o� : : -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E ' '• 2211 E 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Y1n p <br /> PP (including Yaccompanying 1 Y y g : C <br /> I declare that this application includin an schedule has been examined b me and to the best of m knowl- iS t o E <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 <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. I 8 u 8 <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- w <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O�, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m <br /> ,, .m 38 ,x ,` ` uA <br /> SIGN HERE &W <br /> (signatureof owner or burg c tractor) j I`I !'.; ! d_e) ivz <br /> !< i of <br /> ZONING ADMINISTRATOR <br /> I <br /> rlri � N N: 'TI <br /> TOWNSHI PERMITS MAY BE REOUIREL�I�I�� 11 <br /> # 00 S m <br /> -'� 88 888v+ <br /> I <br /> G _ <br />