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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,N, �, 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS d 3_ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 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 a <br /> regulations of the State of Wisconsin. 0 0 <br /> a <br /> 0 OWNER )S � s8 t.� TELEPHONE <br /> l J !llfff,,, Gl <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER 1Z��O Z ROAD NAME <br /> G # it 0 0192 <br /> LEGAL DESCRIPTION (see tax receipt)SOS' ctv (/ o 2 QG <br /> S�I f T (O <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° ct <br /> o < <br /> STRUCTURE/ADDITION USE: JC�n I�t'�+�- -4- +G K%� o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 7 <br /> a <br /> T <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 of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a <br /> PLOT PLAN o n <br /> fn N y <br /> _Sem ,acfaec�� Flo �� fA <br /> o � <br /> l N <br /> (1w n <br /> o (� <br /> N I) <br /> °Q <br /> o �m <br /> T-i Z <br /> l <br /> a <br /> in W r>a O- a <br /> A <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m �� 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =ti <br /> H <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o D <br /> ' B <br /> � : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- . om ! C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o : m m <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $'� $ <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 : O N v <br /> access to the above described premises at any reasonable time for the purpose of inspection. r ; 3 $ <br /> e A N <br /> wo <br /> SIGN HERE ` I <br /> (sigolatuo of ow r building contractor) <br /> 111111 o xE <br /> I � : <br /> ZONING ADMINISTRATOR <br /> 4,���� T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m N p` N N g m <br /> O UtN m un N m <br /> $ $ $ $ $ $ $ $ fA <br />