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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <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 Z fo o <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 J� <br /> regulations of the State of Wisconsin. N o <br /> c <br /> OWNER � tir a S C O IY� TELEPHONEI J O O <br /> _ 3yt3G <br /> m M <br /> ADDRESSag <br /> $Tct� r S�Ucohle �. t <br /> EMERGENCY/FIRE NUMBER Ox163 6.5—' ROAD NAME TNQy'�I A) ^�O GI NQ/S• <br /> LEGAL DESCRIPTION (see tax receipt) <br /> OO J- <br /> CONTRACTOR j e 1061 " O `7-- -T <br /> A <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 10 <br /> n L <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Clip;Commercial Business; Bedroom;Deck;etc.) Z -O <br /> o ° <br /> a <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 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 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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an a N <br /> PLOT PLAN } _._ _ 14 Z Q <br /> yA�r% <br /> 00A d o n <br /> ,4(1g SXe , <br /> N <br /> r <br /> loi , ,a(p N B <br /> r r <br /> or <br /> I = <br /> r) <br /> Z <br /> Im <br /> CONDITIONS OF PERMIT: S.y. ,z c 8 ° 3: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 3 W Q - 1 <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. <br /> g : Er ` C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o @ <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«. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g p <br /> matlon I 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 0 <br /> access to the above described premises at any reasonable time for the purpose of inspection. : a 0 m - <br /> v 0 3y'c <br /> SIGN HERE ure og r ;(signat (date) m i i <br /> ZONING ADMINISTRATORI' <br /> ijl_ <br /> »+N N W N N x�j T <br /> T NSHIP PERMITS MAY BE REQUIRED o v u u U U o m <br /> m <br /> 0 0 0 00 0 0 0 0 0 <br />