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tn;lt ez3yvI <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator -1 c o <br /> APPLICATION FOR — LAND USE — PERMITS 3_ -- <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <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 a <br /> regulations of the State of Wisconsin. m <br /> 6 <br /> OWNER TELEPHONE <br /> (, list l!f/ryry �'1!l/iG C- SO�77 S.3 Y Z Jl}j �7 v <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROADNAME <br /> r�lu �r1GE ®r.uP <br /> 1 rD <br /> LEGAL DESCRIPTION (see tax receipt) za/ Y S 3 S T yZ I-e14 C<" ,4 sm✓ I & <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 0 L <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> 0 <br /> STRUCTURE/ADDITION USE: _ — .-�-3 &,tye o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc. z <br /> ) OC/ 3/ /iiit/ o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I f1 <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 drainfteld (DF). <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building -4 <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ON a ,n <br /> �l z `v <br /> PLOT PLAN o a <br /> Ili r' o <br /> CC' 3 N r.� ' ) <br /> i/° <br /> C) <br /> DJ <br /> uj <br /> z <br /> j/.C4/ � <br /> n <br /> M 6 g a F 0 <br /> V © • N 7J E Lr2 <br /> CONDITIONS OF PERMIT: < m': z CT 8 . i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e O ! 'z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — =N: i 33 <br /> ; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" Z 2 m <br /> g gp. 1 C_ <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 0' <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : "m« : In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 �: $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- d, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 $ [ <br /> /A '/jl))� al m A N <br /> l p. <br /> SIGN HERE <br /> (sip re of ow or building contractor) I� _(date) $ <br /> l o : <br /> ZONING ADMINISTRATOR111 a <br /> ? g <br /> ev en`n 1qtU Foamn <br /> TOWNSHIP PERMITS MAY BE REQUIRED I�', o oN, N . rb� 6 n m <br /> c, In <br /> l J <br />