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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o /o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 <br /> K2�usE, �ebb,-e- 13U-'s-halm -d— <br /> OWNER o TELEPHONE <br /> n O <br /> I O o <br /> m_ <br /> ADDRESS SO'Otl JS)� <br /> �Nb� st A YT– f/(C7fa� m <br /> r JSJ r— �.rn . <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR .raase _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 3 <br /> m r- <br /> STRUCTURE/ADDITION USE: 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z 0 <br /> 0 0 <br /> o �• <br /> m <br /> 3 <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). o <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 rn <br /> Z o <br /> PLOT PLAN n ocs <br /> a <br /> m m <br /> At�a C.h e4 a , <br /> I <br /> � m <br /> 0 <br /> N <br /> 0 <br /> o <br /> m <br /> j b <br /> Z <br /> N N V m r D D 0 <br /> o c m m . n F m <br /> m. Dai x' 2- 0 a m a <br /> m <br /> CONDITIONS OF PERMIT: <. m 2 m o 0 , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 T'2 a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ ^ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' : m2 C <br /> g ac : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m R 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- 6w m F» <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- v mu, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 8 <br /> M N 8 <br /> SIGN HERE w n <br /> (signature f owner or building contractor) (date) o x <br /> ZONING ADMINISTRATOR 1/Yll 8 <br /> w <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N 'u, 8 8 m <br /> rn NU1 2; fnoo , m <br /> 88888888ai <br />