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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminiletrator u �o" ; <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri d and v ro <br /> located es shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of them c Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the I ws and 02, <br /> regulations of the State of Wisconsin. a m <br /> c m <br /> O <br /> OWNER 57 e TELEPHONE a _ 20is o n <br /> (J� m <br /> /y" m <br /> ADDRESS r k izSCYa <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> r <br /> LEGAL DESCRIPTION (see tax receipt)AhAl Se 51c67 ,f/ Q r <br /> t'(Je5f iY)Cl/Sh/ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin Commerci Business;Bedroom;Deck;etc.) o 0 <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> L� <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 (N),septic tank (ST),and drainfield (DF). Y�I <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,( building IVU <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 s fined and 0� <br /> dated by the owner. 0 ° <br /> NOTE: BUKE <br /> BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z c <br /> o n <br /> PLOT PLAN A <br /> fA o <br /> C J V <br /> , <br /> 0 <br /> o <br /> m <br /> n I <br /> Z <br /> IL1^\ <br /> f <br /> M � � � >>am <br /> ag� z�ffig ; <br /> CONDITIONS OF PERMIT: 0 4 ? 1 'Z1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMrr ISSUANCE. 21 rn 1 i _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �5 ? R <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. pQ t' : C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- NOM <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy f all informa- m n <br /> tion contained in this application(including any accompanying schedule)and I further declaro that I recognize t at this infor- n 3 ; g g ? C <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 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 rson to nave <br /> access to the above described premises at any reasonable time for the Purpose of Inspection. <br /> m <br /> M i i m i i <br /> SIGN HERE -- e M <br /> (signature of owner or bull 9C ntrac <br /> (dot 1 <br /> 11 E Qi <br /> E <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED Vt . "'�!� r <br /> 99 8888 i <br />