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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminit#tratorm E <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> c <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri d and c ' <br /> located as shown herein. The undersigned agrees that all work stall be done in accordance with the requiremel of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I cos and <br /> regulations of the State of Wisconsin. <br /> OWNER Qr�f4 SJ �-�41 � TELEPHONE �C.7{�yr^3��� ._ mien £ <br /> ADDRESS 7 jl / / / ��Zi' �XJ_ �?.l <br /> v <br /> EMERGENCY/FIRE NUMBERso <br /> � .. ROAD NAME I&I, <br /> riI r <br /> LEGAL DESCRIPTION (see tax receipt) IfI1,e "36 — � Jrl i <br /> CONTRACTOR <br /> fJ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> STRUCTUREAADDITION USE: L L d' <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z p <br /> 0 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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). g <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. 0 <br /> 4. ff separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 9 SUED. 1I o m <br /> 1r) Z a <br /> PLOT PLAN o n <br /> y�J 7 <br /> � I <br /> m <br /> Q O y <br /> m <br /> 7- <br /> 37s <br /> 37s tj _ <br /> >of m <br /> e 7o <br /> CONDITIONS OF PERMIT: v 3; Q C 8 = 'B C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p f - SQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N' ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' '~Qr" ` m <br /> g ` C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> 0 <br /> o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- - M m�" m <br /> tion contained in this opplic '16nincluding any accompanying schedule)and I further declare that I recognize the this infor- ( B p <br /> motion I am providin/bjIit� h,1c:h <br /> will relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all limay be a result of he County of Burnett relying on this information 1 arm providingin this ap- <br /> plication.I agree lope, unty offioi char with administering county ordinances or other authorized pe onto have access to the sboad Dremi t sable time for the purpose of inspection. <br /> o w <br /> w a <br /> SIGN HERE - ' �^'• ' <br /> (signature of o wn r building contractor) (date) iJf <br /> ZONING DMINISTRATOR �- A';; g i '• <br /> i"Rowa cow Na In <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N B aNr R N$ m <br /> 8 $ 888 $ $8w <br />