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6fl co)) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N 'o + z <br /> m ° ° <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ra <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. <br /> o <br /> m = 1 <br /> c �? <br /> OWNER TELEPHONE ii O <br /> lkr y r / C {z 5 l/- -Z <br /> e o <br /> ADDRESS S'7 (3 M hN I V-� .. <br /> mu <br /> I le �M.✓ ; >Y30 <br /> V C� <br /> EMERGENCY/FIRE NUMBER NLS. -SN'',J ROAD NAME <br /> / e �fedfl ��N � Ira /<r d ll <br /> LEGAL DESCRIPTION (see tax receipt)) '^ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE AD 10N o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <br /> G� 0 <br /> (ir1( o�� r <br /> STRUCTURE/ADDITION USE: o g <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) v <br /> Z o <br /> o � <br /> m <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 infeet 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. <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 /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 11 3 <br /> PLOT PLAN z `o <br /> A ° n <br /> Tf 0 P/0T PL4A M <br /> See c•e o 0 <br /> C ) <br /> on 4m <br /> 0 <br /> 0 <br /> 0 <br /> m � <br /> Z <br /> Z <br /> �i <br /> G <br /> m —g,� '- am nm in <br /> CONDITIONS OF PERMIT: v_' m S. fir <br /> c 5 M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o ' <br /> F n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : $g : C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «•m a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- S o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0�$ <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' ON <br /> access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> m ' vo <br /> SIGN HERE 0 : <br /> (signature of owner or building contractor) (date) ; 8iE <br /> ZONING ADMINISTRATOR )Im . o ` . <br /> g <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N T N , p m <br /> 0000 $ m <br /> 00 fA <br />