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Burnett County 7410 Co. Ind. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR — LAND USE — PERMITSm 3. <br /> a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 the State of Wisconsin. w m <br /> c <br /> m O <br /> OWNER I ,, Z ' TELEPHONE �_ _ y y 7 a <br /> w v m <br /> K <br /> ADDRESS L4,9 S-1 re e Q - eV- W p- <br /> EMERGENCY/FIRE NUMBER _ ROAD NAME �� o <br /> LEGAL DESCRIPTION (see tax rec ipt) L o t l D - tey-e-JP <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION _ o <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 <br /> S (j <br /> r <br /> STRUCTURE/ADDITION USE: Add OYI& � c�l� f7 ° g <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z o <br /> o � <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 <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 LO�ATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o m <br /> 11 Z `v <br /> PLOT PLAN A ° n <br /> M <br /> C <br /> _ _ <br /> I <br /> dn <br /> 0 <br /> N <br /> n <br /> O � <br /> rn �- <br /> 0 n\./I <br /> Z <br /> l I�v�1 <br /> 1 <br /> i! <br /> wq >a 2. O <br /> 31-., :2 W <br /> CONDITIONS OF PERMIT: ,2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =ti: <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" ' O n m <br /> $6 ` C <br /> I declare that this application iincluding any accompanying schedule)has been examined by me and to the best of my knowl- o 43 <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 applicat on(including any accompanying schedule)and I further declare that I recognize that this infor. B g ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o : <br /> further accept all liability whic In 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 <br /> access to the above describei premises at any reasonable time for the purpose of inspection. 3 o m <br /> SIGN HERE <br /> gn�ature of (7 er or building contractor) (date) 3 <br /> ZONING ADMINISTRATOR _ I lmIfl $ <br /> �nwtn�en Fn,n ee n <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N U, fn U1 N $ m m <br /> 00 g o 0 0 0 o fm� <br />