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Burnett County 7410 Oo. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W I C0 O o <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> N <br /> TO THE TONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for <br /> 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 _ `- <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a r ,t <br /> regulations of the State of Wisconsin. -- o V" <br /> OWNER .O tAl� TELEPHONE / IS_ /n _ i.�-� a <br /> L 1 tG/ <br /> ADDRESS '� ) <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 5�y o f 4 <br /> LEGAL DESCRIPTION (see tax receipt) Y� �-F- � 7`y� _ f <br /> CONTRACTOR J oil / C T J <br /> TYPE OF PERMIT(SJ; DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> SANITARY •V// PRIVY FILLING/GRADING ^ O <br /> CAMPING UNIT SUBDIVISION0 <br /> 0 <. <br /> J <br /> STRUCTURE/ADDITION USE: A,PAA) b(1 mul(' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; tc.) 2 T <br /> Q <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or tap 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). (yJ 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 I� <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> X4. 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 /> 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED 0 o N <br /> PLOT PLANz c <br /> m o <br /> ,SeAbc)1eG P)o—j PW 0 <br /> a <br /> MW <br /> 01) <br /> n_ <br /> 0 <br /> J <br /> N la ) <br /> yll <br /> J <br /> J <br /> m <br /> O <br /> N <br /> r <br /> Z <br /> F <br /> in �i g 0 M O <br /> -$� J- am °,mm <br /> CONDITIONS OF PERMIT o' m H c g 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o =i2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m fn <br /> a C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. rn m dr: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor B G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o <br /> further accept all liability which may be a result of the Count f Burnett relying on this information am providing in this ap- <br /> plication. I agree to ennit county officials charged with a0 i staring county ordinances or other thorized person to have O N v f <br /> access to the abov ascribed premises at any re onabl t' a for the purpose of inspection. mom <br /> �1 € Sot <br /> m a A N <br /> € € w s <br /> SIGN HERE ho-pvl - <br /> (signature of n i tor) a ) <br /> o : <br /> ZONING ADMINISTRATOR <br /> / J a H W y v T <br /> 0 08800 <br /> T NSHIP PERMITS MAYBE REQUIRE /' Jo N N u, m m m NN <br /> u u <br /> J <br />