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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0Z o 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 57 <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. <br /> J c m <br /> m O <br /> OWNER N TELEPHONE <br /> o � m <br /> ADDRESS/6) <br /> EMERGENCY/FIRE NUMBER Z-2��� ROAD NAME/,/,)/77 <br /> LEGAL DESCRIPTION (see tax receipt)/T��/LJy� //�L',5�,5L"�f�D� 5 �vy/✓,_�J/ .fi <br /> ') <br /> CONTRACTOR <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 77- <br /> o ^. T <br /> �'i�,2 � <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Ca mmerciel Busin ss; Bedroom; Deck; etc.) Z o <br /> � 9 <br /> N <br /> 3 <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 infest of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building 1A <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 /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'tI c N <br /> c <br /> PLOT PLAN n o n <br /> C <br /> M �S <br /> 1) iU <br /> 1 �1 o <br /> o <br /> � J <br /> 1 <br /> / ' z <br /> f <br /> m <br /> 2. <br /> CONDITIONS OF PERMIT: m Q c 0,5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o : Z —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. S1 0 32 m <br /> o ; aE. : <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- » m ii; : C <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 I recognize that this infor a o ; m <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 which may be a res he County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit co ty officials har administering county ordinances or other authorized person to hav <br /> access to the above descri pr ises reasons Is time for the purpose of inspection. m o m <br /> vA0 <br /> : wo <br /> SIGN HERE <br /> (s' n ure of ow r r uilding contractor) (�d S p,, [ � <br /> t�----- _ : <br /> 0 : <br /> ZONING ADMINISTRATOR S <br /> TOWNSHIP PERMITS MAY BE REQUIRE JUL / O O N N N N N p m <br /> 0000g000 vmi <br />