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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'Da a <br /> IE <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � c <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 <br /> regulations of the State of Wisconsin. <br /> m <br /> c <br /> m O <br /> OWNER 5��E-li<�/y /� TELEPHONE-4y. <br /> v m I- <br /> ADDRESS"�� /f{rG/.P<=..�� <br /> 0�9 7S- �<•c .�--y 5'i �ir/ ��c_>r�a7i'�!-� 1�-"t SSSS 5Y� l}.� ' n <br /> EMERGENCY/FIRE NUMBER ( ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) �iy/r✓�II,G l� �tls 7 y�U <br /> (l> <br /> CONTRACTOR <br /> Tvrc or PEHMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE _ ADDITION o <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 0 <br /> r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) Z ° <br /> 0 <br /> 0 <br /> a <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). .ori <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -q <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 9 a N <br /> c <br /> PLOT PLAN ____ n o n <br /> 0 <br /> C (� <br /> 1 �p� m <br /> CC_1� o <br /> D <br /> r- <br /> N <br /> 1 �O <br /> N � <br /> To-epi o of-0 <br /> CONDITIONS OF PERMIT: c 0 N.: CS . i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e F 9 : -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =N y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 32 m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my know$- o C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of allinforma- (n y w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g rh <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I oo <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O m o <br /> access to the above d ribed premises at any reasonable time for the purpose of inspection. : mom <br /> mT m A <br /> S <br /> SIGN HERE o.8 i` - <br /> (si atur of owns g contractor) 0-1 <br /> C : x <br /> ZONING ADMINISTRATOR � � � � S <br /> Milli <br /> aa«.«tna`y to <br /> TOWNSHIP T <br /> PERMITS MAY BE REQUIRED <br /> P-j <br /> m000 <br />