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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c o <br /> APPLICATION FOR — LAND USE — PERMITS >E <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc Fibed and Q w a <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 �_ $ <br /> regulations of the State of Wisconsin. <br /> OWNER /ONAj'0 Jr aSGH/,y/F�yL:�r•/ TELEPHONE 71 ?`SOw m0 ^ £`' <br /> o <br /> m_ m <br /> ADDRESS ly,7.6rPIN /t?f1.4 X,41Vo /Nb ,� AN.OU r- <br /> EMERGENCY/FIRE NUMBER SAMA <br /> see taxrecei <br /> ( pROAD NAME �� ���� <br /> LEGAL DESCRIPTION tri) 1�- u, <br /> CONTRACTOR KI <br /> V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING A GE/ CCESSORY STRUCTURE ADDITION <br /> O r <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: ( �R�6� - I o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> 0 0 <br /> } <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 Nor h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DIF). 0 <br /> 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 <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 si ned and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 1I o y <br /> PLOT PLAN /1llegg✓ 9K z `v <br /> o o. <br /> 0 <br /> q �ovsE' d m <br /> Ix 6.6 <br /> 44 n <br /> Cul r y <br /> q Cr,4 GAGaGrE [� <br /> o a <br /> !� I Z <br /> e g G =_.a Qo m <br /> CONDITIONS OF PERMIT: o m 2,: c g,� � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ gpi m <br /> Lr D <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 II informs- n " `+row : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- - i �' g }S ? C <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I ,�J : $�$ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin In this ap- E ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pen on to have <br /> access to the s described premises at any 7nonable time for the purpose of inspection. T <br /> SIGN HERE &4141 ` <br /> AsIgIffure of owner or building contractor) ( ts) <br /> ZONING ADMINISTRATOR ' 4 y --t �' 0: <br /> n�+NNN�N�« T <br /> TOWNSHIP PERMITS MAY BE REQUIRED r o m m $ K e, N$ m <br /> 88888888 ai <br />