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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C O o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 0 <br /> 70 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 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 o \ <br /> OWNER /� a,•p i sof / rZ�ny?:� i ) TELEPHONE o E <br /> �Ir��JCK L J )fJ..eZRn>ZIAj/ `L. /V`l J <br /> ADDRESS q 3g ,LAR✓/A7� �� �O Jul Cl�l(-r(_� IY�� SS't�'�-"� ' , \c� O <br /> EMERGENCY/FIRE NUMBER j ROAD NAME SrJV��p <br /> LEGAL DESCRIPTION (see tax receipt) ` ` <br /> CONTRACTOR ?� �tFr q . �C3 - ` <br /> TYPE OF PERMIT(S): DWELLING/BUILDING "A, _ GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> ti <br /> SANITARYPRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> J �• <br /> /' <br /> STRUCTURE/ADDITION USE: H.."�' <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z p <br /> (A <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 infeet of the following:(a) building to all lot lines,(b)buildingto 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 SO <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1111 v rn <br /> PLOT PLAN 4 Z <br /> O a <br /> m �; yo <br /> m � <br /> 41 <br /> M. <br /> Co <br /> J <br /> 0 <br /> Z <br /> s <br /> I� <br /> D z <br /> 0 f/) r ODp Mo <br /> 0 o, � m m c a m <br /> M. <br /> L _ mem a: _ 31 <br /> CONDITIONS OF PERMIT: < C mO o <br /> S. N `Z N J (Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 rQ � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ »� � m <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' 'm C <br /> 8 2c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- r o_ : i m a m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- w m w : O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 �? 8 <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 p <br /> access to the above_ded premises at any res le time for the purpose of inspection. v 8 R <br /> T <br /> SIGN HERE <br /> (signiture of Owner or buildirif g6ritract'60 (date) <br /> o : <br /> ZONING ADMINISTRATOR jing <br /> 11 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> rnrn . u oo . m <br /> 99 999 ai <br />