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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' O a <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 C _Z) <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. y ° <br /> c <br /> �+ �i c <br /> OWNER �D BC& ! G OIYZ F/%/2 j/Y TELEPHONE ��j 6 — 84-/ Z n <br /> o ' <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER J 3�g ROAD NAME A/ <br /> LEGAL <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR R. yy /C. CO ffs i V" <br /> TYPE OF PERMIT(S)/:\DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—y ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT_ SUBDIVISION o ° <br /> / J <br /> STRUCTURE/ADDITION USE: 0� , m <br /> i o <br /> (Home/Cabin;Commercial Business;B oom; Deck;etc.) z v <br /> o ° <br /> 0 <br /> m <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 <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Milt o rn <br /> c <br /> PLOT PLAN � / n o n <br /> M o <br /> J <br /> 1 <br /> Cor rNE <br /> Z4 <br /> led <br /> 0 <br /> J <br /> 75 / N <br /> O <br /> J �1/ <br /> O y <br /> PR V�rE <br /> 2D z <br /> oa <br /> f <br /> m =g,��' am g-m m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m - Q —1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =to <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O m <br /> i m <br /> I declare that this application lincluding any accompanying schedule)has been examined by me and to the best of my knowl- o m <br /> C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : Xlm i m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation <br /> 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 provitling in this ap- ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to nave N <br /> access to the above described premises at any reasonable time for the purpose of inspection. r i 3 0 <br /> a D m <br /> O � <br /> SIGN HERE <br /> (si aature wrier or but ntractor) (date) `a <br /> ZONING ADMINISTRATOR ✓ 8 - <br /> 0 <br /> T. <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N M N o of N m <br /> 0000000011) <br />