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Burnett County ?410 C . Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m I 1 m o �Z <br /> APP (CATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and 'z w <br /> located as shown herein. Th 0 undersigned agrees that all work shall be done in accordance with the requirements of the \ <br /> Burnett County Land Use Or inance,Sanitation Code,and with all other applicable County Ordinances and the laws and 1 <br /> regulations of the State of Wi consin. -. <br /> N d <br /> N 0 <br /> OWNER) G _S TELEPHONE TELEPHONE <br /> O7 = 7,;Z ? 3 <br /> ADDRESS <br /> 18,411S-t <br /> it <br /> LLS s-Y <br /> EMERGENCY/FIRE NUMBER E7ROAD NAME ) <br /> LEGAL DESCRIPTION (see tax r ceipt) 1� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN /BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION �m <br /> o v <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT__ SUBDIVISION o <br /> o < <br /> J <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> Z o <br /> o 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 (NS) and indicate North (N). <br /> 2. Show the location of the ell (W),septic tank (ST), and drainflaid (DF). <br /> 3. Show dimensions Infeet o I the following: 0 <br /> g:m k of lake, all lot lines,(b)building to center line of road,(c)building 0 <br /> measurement to the ordin try 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 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on v <br /> PLOT PLAN 11 Z Q <br /> o n <br /> m o <br /> SE's C <br /> oolv011 <br /> DO <br /> 0 <br /> J <br /> N IJP' <br /> J <br /> J <br /> O <br /> i. AI <br /> ZVVV��- <br /> I fIyL� <br /> I <br /> r0 a* <br /> CONDITIONS OF PERMIT m D g� a qram 90 m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m ii' �.z <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, P F ' fn <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 62 6 2 m <br /> aa <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g a E - . G <br /> 0 : m C_ <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 H 6: <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �' o m <br /> mahon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing in this ap <br /> G <br /> plication.1 agree to permit coup y officials charged with administering county ordinances or other authorized <br /> person to haveN <br /> access to the above described O O remises at any reasonable time for the purpose of inspection. � � m g � <br /> i <br /> SIGN HERE `+ i 10 S i <br /> o : <br /> (sit #Of <br /> owns Ar uilding contractor) (date) <br /> ZONING ADMINISTRATOR � ' <br /> $ <br /> TOWNSHIP P RMITS MAY BE REQUIRED o N N N o N m <br /> S $ $ $ $ $ $ 8ai <br />