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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work clescrited and � u � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the $ � <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the Is Ns and <br /> regulations of the State of Wisconsin. m <br /> m <br /> OWNER TELEPHONE 0 <br /> I�Np,Ap G?UFE/✓E, <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 5/ —/ ACd,32 koV _ <br /> y v/mow sig ,cor " 1 -� <br /> CONTRACTOR QIVk <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> 0 <br /> N <br /> STRUCTURE/ADDITION USE: $ o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> 0 00 1 <br /> M <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 dralnfield (DF). 5 <br /> 3. Show dimensions in feet ofthefollowing:(a) buildingto all lot lines,(b)building to center line of road,(c)t uilding <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 sigr ed and 0 V <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. on <br /> 0 a <br /> O N <br /> PLOT PLANLzzr,_ — — Z c <br /> A o n <br /> A o` <br /> /In r viPa — C C3 CC , <br /> /S6 H��� z8' G�egci In <br /> � 6r l <br /> If 7y —� ✓� <br /> //ousAr rB ° <br /> J <br /> 0 <br /> 26/ <br /> well <br /> / /oic 20, <br /> /D c -613 <br /> /b� f N6 Ibrx2y' Roof, <br /> ofrrc/Q Gxr Orel( <br /> M ie in <br /> v <br /> XI <br /> CONDITIONS OF PERMIT: wA��R I-t �rLwpJD LA�r v m 2- <br /> REQUIREMENTS <br /> S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o: �Q <br /> o —_N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - t7 - In <br /> 8E ` E C <br /> I 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 informa- <br /> tion <br /> forma- «ro e+ I'm <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i4 i p <br /> mahon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a I omit. 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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection, a <br /> SIGN HER <br /> (sig to of own r building contractor) (date) <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 4,U -n <br /> $ $ $ $g$ 88u) <br />