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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ca O o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONINGADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 Courcy Ordinances and the laws and <br /> regulations of the State of Wisconsin. a 1J <br /> c <br /> OWNER , �S"� TELEPHONE ��j_ 7 0 E <br /> ADDRESS _ v /� �L / r'�(\� Q <br /> EMERGENCY/FIRE NUMBER ��/�J �pROA NAME <br /> t.r�-,.y. � �- Y✓ <br /> LEGAL DESCRIPTION (sae tax receipt) 1.0��Q V�/V1U s asy ,Sec, dy y-typo,-p/60 CY1��1 <br /> CONTRACTOR <br /> ��iC��/J�� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE�! ADDITION p (D <br /> C T <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: XS30f62 % 0 <br /> (Home/Cabin;Commercial aS <br /> g <br /> Business; Bedroom;Deck;etc.) Z o <br /> o v <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 dralntleld (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 .4 <br /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M Q <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATONS MUST BE STAKED FOR ONSfrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 41 v m <br /> PLOT PLAN <br /> o o <br /> SeQ M <br /> NI <br /> nl � <br /> u <br /> Q � <br /> N <br /> 8 O <br /> 0 I� <br /> aO <br /> O r <br /> m <br /> Z <br /> D <br /> 1 I� <br /> m <br /> Ba : � <br /> CONDITIONS OF PERMIT: 0 2 -' Z c:8 g� ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` rrr '• m0 <br /> � E C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- ? p�ri , a <br /> wipe and bsllsl it is true,co tend complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 1"�i 73? m <br /> tion contained In this ap tali (Including any accompanying schedule)and I further declare that I recognize that this Infor- i5 Y@ <br /> motion I am providing ill be lied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 $ 8 <br /> further accept all Habil y which may be a result of the County of Burnett relying on this information 1 am providing In this ap- <br /> plication.I agree to W It cou ty officials charged with administering unty ordinances or other authorized person to have <br /> access to the above n Dnmiwa rouonaDls lime r th purpose of Inspection. <br /> T i i <br /> ' i <br /> SIGN HERE « <br /> (sae atu of owner building contractor) (date) <br /> i <br /> ZONING ADMINISTRATOR <br /> �! «' « <br /> TOWNSHIP PERMITS MAY BE REQUIRED o B ' R, �I'R m <br /> 88 $ 8$ Im <br /> 8' 8 U) <br />