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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 0 <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 v w <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 J" <br /> regulations of the State of Wisconsin. m <br /> N <br /> v ,Ile �' 6)L46 /lie/, 7/5--Jaz -'j`d'73 o U o <br /> OWNER TELEPHONE £ <br /> ADDRESS © Z/ n(V1er, S/ YW /� <br /> EMERGENCY/FIRE NUMBER ROAD NAME &z r��Oh <br /> ky �C 1Jl <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR '✓ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> m <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o < <br /> C' /�p.e N r <br /> STRUCTURE/ADDITION USE: 4M 0 g � <br /> (Home/Cabin;itommercial Business;Bedroom;Deck;etc.) Z o ^- <br /> o <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). o <br /> 3. Show dimensions in feet ofthe following:(a)building to all lot lines,(b)building to center line of road,(c)building -q I _ <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 N <br /> c <br /> Z o <br /> PLOT PLAN A o <br /> M N_ <br /> O <br /> C <br /> 0amj)eA- on LcT <br /> I <br /> N <br /> 0 <br /> O y <br /> m <br /> Z <br /> g <br /> —a <br /> o.A &m m <br /> CONDITIONS OF PERMIT: v y; Z CS 5'8 r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z e 3 <br /> o F 5 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <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 all informs- ' G <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $� r <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 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. �, <br /> ' a N <br /> �, 777000 <br /> (SIGN HERE <br /> signatureof owner or building contractor) (date) <br /> ✓ JC <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMIT MAY BE REQUIRED o .uul ,uu,, �p° �5`m m <br /> 888 vi <br /> d X <br /> 0 <br />