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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator or ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i 0— <br /> located <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremi ints of the � <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and -_ <br /> regulations of the State of Wisconsin. w m <br /> u <br /> C O <br /> OWNER � � E TELEPHONE <br /> o m <br /> ADDRESS oZ3 �SLi / Sh£ tF�l� ltil ' <br /> EMERGENCY/FIRE NUMBER ROAD NAMErw <br /> L <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> '^ r <br /> STRUCTURE/ADDITION USE: o °- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z 0 <br /> 0 0 <br /> 0 <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. Showdimensions Infest ofthefollowing:(a)buildingto 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. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s gned and <br /> dated by the owner. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I3 m <br /> 1A o <br /> PLOT PLAN Z l��,— A o a <br /> �\ 0 <br /> C <br /> ( m C <br /> � I <br /> n <br /> 0 <br /> - o ,. <br /> m <br /> o <br /> U iw 4,,0 <br /> - - <br /> Y <br /> T <br /> beN�2. p0IT <br /> m, ]Ogg ffnm m ID <br /> CONDITIONS OF PERMIT: '^ i �-�, ; Z `$ g� ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e £ = �`z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( � =N ]7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V! N m <br /> Qggi C) <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl- ( o! !i '• C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- --- i �"a`" r�r1 <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- --- i $ B p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue,a permit. I i <br /> further accept all tiahuity whlnh mev ha a ma.at,.t th.Cn,,,.n..d o..--ett relying on this information 1 am providing In this ap- <br /> plication.1 apr )county ordinances or other authorized person to have <br /> 0. m <br /> access to the to purpose of Inspection. <br /> 7 <br /> SIGN HERE_ <br /> '^ <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR <br /> ArK 1 O RMNMM+�NNH+� -Tt <br /> TOWNSHIP PERMITS MAY BE REQUIRED v,N N N N l5 m <br /> "�� 'x,!8888888 ami <br />