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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord 0 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 0 <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. H d <br /> w <br /> OWNER I/�L ��/PIYI TELEPHONE <br /> /Y 7� m m <br /> ADDRESS >I <br /> EMERGENCY/FIRE NUMBER �9 1S�1� �7 ROnAD NAME F/ /0 Al `n .cry- /OC2 i a <br /> P) / uIS t/I// t71 (06ViLfs—�td�/1",a S'6 ,1 �i <br /> LEGAL DESCRIPTION see lax recei t <br /> CONTRACTOR 00 rt/ �J V Nc 0 N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o - <br /> L <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> Po ���(N( J " <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commere Business;Bedroom, eck;etc.) - z o <br /> 0 0 <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 drainfieid (DF). <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 fake,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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I c N <br /> 11 Z Q <br /> PLOT PLAN P c <br /> M o <br /> m o <br /> J ¢ <br /> � o <br /> O N <br /> C✓ o` <br /> 0 o� <br /> S �- <br /> m <br /> O v� y <br /> N <br /> I� <br /> � G <br /> z <br /> � T <br /> 8 ofm <br /> CONDITIONS OF PERMIT* Z T a T+_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F I �� - <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. �'j o p <br /> � �: Zi E C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- _I:: g <br /> o g <br /> edge and belief it is true,correct and complete.I 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 1 recognize that this nfor. l o : p <br /> mation I am 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- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized parson to have 00 o <br /> access to the above scribed premises at any reasonstime for the purpose of inspection. 3 $ m <br /> m A m <br /> SIGN HERE <br /> g ur of owns r wilding contractor) (date) <br /> ZONING ADMINISTRATOR �L� <br /> TOWNSHIP PERMITS MAY BE REQUIRED NNN0 <br /> 00 , Vm <br /> 000ornu) <br />