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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3on <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 <br /> regulations of t e State of Wisconsin. 0 <br /> H m <br /> Zrald Pivar� <br /> n / ` O <br /> OWNER GUAAO TELEPHONE <br /> 3�1 s (Lfa"cd �vsr ADDRESS <br /> EMERGENCY/FIRE NUMBER 7 ROADNAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR L dUruGPn./ CL'rvS <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 17 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o ` <br /> STRUCTURE/ADDITION USE: 21 Yu 40 k/O Cs AIA Cj, o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 0 <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). <br /> 3. Show dimensions in feet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building 7) <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 9 <br /> dated by the owner. 0 0 (C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on N <br /> PLOT PLAN n 0 nw <br /> pyo �nA M <br /> &Y C 3J ° <br /> m , <br /> AP Odl fV - <br /> I <br /> 6/ 3> <br /> o r N <br /> � N l/ (p <br /> a y tqa <br /> m <br /> 1 N � Z <br /> I � <br /> tocrjn 6 n n m <br /> m D -.. 6me = � <br /> CONDITIONS OF PERMIT: v : Q 0 5 .0 r'o <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ - Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` N ` n m <br /> g ig C <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- "I a: rmrt <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,9 a o ; p <br /> matlon I em providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I oo <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 0" O <br /> access to the above described premi at any reasonable time for the purpose of inspection. „ 3 'oo <br /> O m A H <br /> SIGN HERE/ �� 030 c= - <br /> a: <br /> (signa ure of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 8 : <br /> wwu�en rn r•�n en -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED O 0 V twlN m m p M m <br /> 000g000grmA <br />