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Burnett County 7410 Co. I Id. K, No. 102, Siren, WI 54872 Office of Zoning Administrator e o 0 <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> ersig by application for a Permit for the work described and u � <br /> located as shown herein. The u xiersigned agrees that all work shall be done in accordance with the requiremema of the u = <br /> Burnett County Land Use Ordi ince,Sanitation Code,and with allt other applicable Count'Ordinances and the laws and �. <br /> regulations of the State of Wisc nein. o <br /> m m <br /> w u <br /> c O <br /> OWNER TELEPHONE / _ E <br /> ADDRESS <br /> � l l <br /> EMERGENCY/FIRE NUMBER ROAD NAME —+ <br /> LEGAL DESCRIPTION (see tax rec ipt) <br /> CONTRACTOR 04 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING- GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> O <br /> 0 <br /> r <br /> STRUCTURE/ADDITION USE: t Vq o o <br /> (Home/Cabin;Com ercial Business;Bedroom;Deck;etc.) <br /> = o' <br /> 0 0 <br /> m <br /> DIRECTIONS FOR PLOT PLAP I 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 wi ill (VI),septic tank (ST), and dralnfield (DF). <br /> 3. Show dimensions In feet of It is following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinal high water mark of lake,stream,or river. <br /> 4. If separate plans are subml ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOC TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o N <br /> PLOT PLAN Z c <br /> �r1V WIL 0 <br /> J <br /> 7 7_ Pro Ak At�� LA1t4l9r LI he titPA Z-cc� n"I <br /> 7 3,5 Croom Coo4y Kd- r4 0 <br /> s <br /> is— <br /> , o <br /> N s <br /> O I (� <br /> b <br /> O ti <br /> N <br /> ��� ►l Lod/ be, �vcc�ed n�G h���rz 3 <br /> �i 5 �n cl�G c'c� d ,'� -�h �, �e5 nG �t = <br /> J <br /> f <br /> R �_ F & m <br /> 0.10 <br /> CONDITIONS OF PERMIT: v g C8 g a ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N'• S <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '• r^ `: O m <br /> I declare that this application(in ludinp any accompanying schedule)has been examined by me and to the Neat of my knowl- <br /> E C <br /> a" a <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- E "a « i <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor• p <br /> mation I am providing will be r Had upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I ig $ <br /> further accept all liability which Ttay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit tour y officials charged with administering county ordinances or other authorized person to have ` <br /> access to the d scrl remi"A at any reasonable time for the purpose of inspection. <br /> -n <br /> i <br /> N <br /> SIGN HERE ' <br /> (sig st O O ding cont ...1 \ <br /> ZONING ADMINISTRATOR $ <br /> 99 TT w�NM M� T <br /> TOWNSHIP PERMITS M REtlI1141 z ( ( 8; 8 it �'. m <br /> 88888818'8 rn <br />