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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <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 d <br /> m � <br /> c <br /> m <br /> OWNER / o TELEPHONE � n n <br /> L-.er S /J� 3s yrs xc o_ <br /> ADDRESS 2 7 Y7 n a � vd /AS AegA <br /> m <br /> EMERGENCY/FIRE NUMBER 2 7y7 '2 r� NROAD NAME t �j r4 A�dr l <br /> cS� A B <br /> LEGAL DESCRIPTION (see tax receipt) C 3 .-41 3 �S� <br /> 1 7/ 7 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWEiLLLING/BUILDING GARAGE/ACCESSORY STRUCTURE� ADDITION v <br /> n o) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 �- <br /> STRUCTURE/ADDITION USE: S 1 �SGA ti r�' JTIf r D l� /`-��/ ° o <br /> v <br /> (Home/Cabin;Com rcial Business;Bedroom; Deck;etc.) 0 0 <br /> D <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). 0 <br /> 3. Show dimensions in feet of the following:(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. Q <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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 m <br /> Z `c <br /> PLOT PLAN EAG`K�I 0 n <br /> rn o <br /> C <br /> I � <br /> M <br /> D_j Eli I <br /> �1 <br /> 153 C o <br /> 3,Yr � t <br /> I� <br /> 6. <br /> V _ <br /> E <br /> I 37 _ N g G <br /> t P I i <br /> I i <br /> X33 � <br /> i <br /> D o c m m a <br /> m <br /> I /A 31m Dff m aN ? = a <br /> CONDITIONS OF PERMIT: e• S m p Q c o 0. 19 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = r^ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I I O' ,4 <br /> ig c C <br /> g n , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g I m m <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs w m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i <br /> 8 8 <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i O No <br /> access to the above described premises at any reasonable time for the purpose of inspection. m v g <br /> m <br /> SIGN HERE <br /> (sig tturree of er or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIREDN ,'o . b m <br /> $ 8 $ 8 8 ) <br />