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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO 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 Ordina ce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wiscon 5in. w m <br /> m <br /> n O <br /> OWNER �Q it <br /> Siit 1-+ TELEPHONE <br /> ADDRESS � - qSo gG. W6— 17 m <br /> 6-YO -! <br /> EMERGENCY/FIRE NUMBER ROADN'A-ME OVh pR' <br /> LEGAL DESCRIPTION (seetaxrecei �t) SE S f S— I 1 �. l� 1\ l "- <br /> 1 <br /> CONTRACTOR S A <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o C <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION r <br /> (r� " r 1 <br /> STRUCTURE/ADDITION USE: 61A �Q p 1 �e o 41 <br /> v <br /> ome/Cabin;Commercial Business; Bedroom; Deck;etc-) Z a <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) { ? <br /> 1. Show the location and size f all existing buildings (EB) and all new buildings (NB) and indicate North (N). fl[ <br /> 2. Show the location of the we I (W),septic tank (ST), and grainfield (DF). IIS ,�., <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building 1 <br /> measurement to the ordinaq high water mark of lake,stream, or river. <br /> 4. If separate plans are submitt ad by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o N <br /> 11 Z Q <br /> PLOT PLAN A o n <br /> m o <br /> o n <br /> 0 <br /> IJ <br /> o <br /> Z <br /> I^ <br /> A �cmaN+ r->> -v <br /> D � '-d am c= M <br /> CONDITIONS OF PERMIT: < m' `Z C6 - Q ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9 <br /> in: o <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. " O n C <br /> I declare that this application(i eluding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correcl and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «�m m <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- : `,a B i p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $`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. <br /> y, <br /> plication.I agree to permit coun ty officials charged with administering county ordinances or other authorized person to have O m o <br /> access to the above described 3remises at any reasonable time for the purpose of inspection. T 3 0 <br /> N m K N Y <br /> SIGN HERE 'n [ <br /> (si nature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> «+«tea m <br /> TOWNSHIP PERII MAY BE REQUIRED <br /> 006 o m <br /> to <br /> 0 <br />