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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N v iz <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 0� <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 Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. m <br /> n \ m <br /> sss <br /> OWNER e `-n �^f /1.- / �-� TELEPHONL-/J S'�� 7 9SL/ a � O JJJ "'vvv J j F <br /> O � <br /> m_ m <br /> ADDRESS �8L19S- —r It /.,Pe W i 1-e �� m <br /> EMERGENCY/FIRE NUMBER a 4'l(C)S' ROAD NAME <br /> O I II <br /> LEGAL DESCRIPTION (seetaxreceipl) SUJ YQ _�� w VU <br /> CONTRACTOR J Y !C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o <_ <br /> � � C <br /> STRUCTURE/ADDITION USE: o ° <br /> Home abin;Commercial Business; Bedroom;Deck;etc.) z v <br /> 0 0 <br /> v <br /> m <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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building IL <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 M <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a /J <br /> PLOT PLAN <br /> VI^ <br /> C 91 <br /> m <br /> c � <br /> a <br /> U-3 <br /> I <br /> o <br /> N <br /> O <br /> m <br /> w <br /> � a <br /> Z <br /> i�c��i �o ave <br /> n _F,, a 2. g:m M <br /> m D- .6 m e _ <br /> CONDITIONS OF PERMIT: a Q c <br /> . <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - 1 stn I 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N i 62i <br /> o : : B 6 ? i O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o g I C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ( " . a m d'I rh <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. 8 id g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <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.I agre to permit county officials charged with administering county ordinances or other authorized person to have O N v <br /> access to thea ve describ premises at any reasonable time for the purpos of inspection. <br /> 7 q m m <br /> SIGN HERE ,+ UVIf _ I3- 13 <br /> (signature of owner o b I In c r d (date) <br /> o xE <br /> ZONING ADMINISTRATOR <br /> dl HHtl1H -t <br /> TOWNSHIIIII PERMITS MAY BE REQUIRED 'o ^ a m <br /> gg goo fA <br />