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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w -a -1 c <br /> APPLICATION FOR — LAND USE — PERMITS _ <br /> w � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v zi o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. w m <br /> OWNER( � ,&„O _ ifo`I I <br /> w I <br /> ADDRESS /) ., ..1 <br /> EMERGENCY/FIRE NUMBER ,[ ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Lot /-12 ds'M�.+/.1 row C!9,004 &1a <br /> CONTRALTO o do t ��d�nsd h 5 KS <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> '^ r <br /> STRUCTURE/ADDITION USE: o ° <br /> \ <br /> (Home/ abin;Commercial usiness;Bedroom;D ck;etc.) o <br /> Z o <br /> 0 c <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). 7) <br /> 3. Show dimensions in feet ofthefollowing:(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 M () <br /> dated by the owner. 0 o (]-' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUSc <br /> T BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. �I N <br /> c <br /> PLOT PLAN o a <br /> `- <br /> m o <br /> C <br /> i <br /> wLd <br /> a <br /> m O <br /> 4 Sao c <br /> 1 <br /> ` f <br /> L 0 <br /> 0 <br /> IV, <br /> Z <br /> yso s <br /> �0NN V fnrD 11 <br /> o c a. m m m <br /> = a� a 'aN <br /> m <br /> CONDITIONS OF PERMIT <. m E m o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F r� <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. �'� ' o m I C <br /> C : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o n 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 informs <br /> a yr m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- is . . <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. Y$ m <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this '� ate„ fn <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to h 5"0 N o <br /> access to the above described premise^aj reasonable time for th purpose of inspection. m ?-� 88 . <br /> i i i m A <br /> SIGN HERE A <br /> m <br /> (signal re of caner or building on r oToa{-pa <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP P RMITS MAY BE REQUIRED <br /> ` ,�` ^ � N8S88 <br /> m <br /> 8rn <br /> --- uv . <br />