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Bbrnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0y l m o c <br /> APPLICATION FOR — LAND USE — PERMITS m 3.TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v o <br /> a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. y d <br /> C A <br /> r ^^�� m O <br /> OWNER B e r im 1 Pe h N ^'T� L✓TELEPHO`N'E A 1/1,(,�� y� 3-'1 0 <br /> ADDRESS I� f FP-edc�� .V f 11/2 ( ��l�r)�;I v/ rrVV� `J��_1 / m m,\,�.�`��� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> NUJk NUJ <br /> V WA 3—�D q T"3"7 9- I Sr <br /> W <br /> CONTRACTOR <br /> IL <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION v - <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> STRUCTURE/ADDITION USE: o = S <br /> o /Cabin; Commercial Business; Bedroom; Deck;etc.) Z m <br /> O O <br /> a <br /> m <br /> D <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) so <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). r <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building q <br /> measurement to the ordinary 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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 m <br /> Z pQ c <br /> PLOT PLAN o a <br /> y <br /> f O <br /> J <br /> N � <br /> Il <br /> N III�I�ww_yyy(( <br /> = � I <br /> Z <br /> m e 3W r n a v e <br /> m, DK'� 2.n. 9-. 0 I'm <br /> } <br /> CONDITIONS OF PERMIT: o ; Z CS 0 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 1 i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ( N 2i i m <br /> W <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. (n y a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- J B <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O m v <br /> access to the above described Premises at any reasonable time for the purpose of inspection. 3 0 3m'c <br /> 0 <br /> m m <br /> M m O <br /> SIGN HERE <br /> .8(signature of owner or building contractor) (date) H <br /> 0 x: <br /> T F� . <br /> ZONING ADMINISTRATOR I <br /> M HH6)fA M <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N m <br /> 00 0 Boot) <br />