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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c �. <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w <br /> I �r /tn'Y I'/,/�/I/�� (/ E /' q m O <br /> OWNER Do /-, T iKfe- ! ' 'r l- L I-TSL PHONE :71,r- 6 2.S - 2,9 /, <br /> — <br /> ADDRESS_ C� S–iq C.f�wr✓� iC a� A I m IN <br /> EMERGENCY/FIRE NUMBER '30f C ROAD NAME Co g)l !n rot n �_ <br /> Q�LEGAL DESCRIPTION (see tax receipt) S S E / ql r �d� `V &k O'C' Cc 0'"4 <br /> T <br /> CONTRACTOR S<� <br /> TYPE OF PERMIT(S): ELLI UILDING_�_ GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 0 L7 <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` °- <br /> _ <br /> w 0 <br /> STRUCTURE/ADDITION USE: Ern 2 <br /> v <br /> �(1-ome/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 0a <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). ° <br /> 3. Show dimensions Infest of thefollowing:(a)buildingto all lot lines,(b)butldingtocenter line ofroad,(c)building O <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 9 <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> 11 z `v <br /> PLOT PIA n <br /> L. / C <br /> a 4Z <br /> y3r �� 'AO <br /> a <br /> I I S I <br /> ON _� <br /> GIS <br /> X36 94 7 UI <br /> L.l.� <br /> YYt 0 w� <br /> u <br /> ,I J <br /> z <br /> (fltih <br /> 7.0l� LST (.cam �$4•�-213/F�'. <br /> rd <br /> r� <br /> —_ - -- – <br /> _ A o c m& 0 M <br /> m. Dnq am <br /> . <br /> CONDITIONS OF PERMIT: c <br /> � � 'a': ? m o =o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 o o <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. i O n p <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my know,- c m u <br /> O ` m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 5 m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- i <br /> m <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit.informal- <br /> ? $ m $ ; <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- N <br /> plication.I agree to permit eoun offic' Is charged with administering county ordinances or other authorized person to have 0� <br /> g <br /> access to the a de rwed rem, s at any reasonable time for the purpose of inspection. - <br /> � A <br /> SIGN HERE - - m ' <br /> (Signatu�towner or building contractor) (dat i $ <br /> g _ F : <br /> ZONING ADMINISTRATOR r i ; q' p <br /> N U N N O - <br /> TOWNSHIP PERMITS MAY BE REOUIRED 8 8$ $ $ $ 8 <br />