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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m c o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2w) <br /> located as shown herein. The undersigned agrees that all work shell be done in accordance with the requireme s of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. y m <br /> OWNER / ,� 1� 4(f�EL PHONE �' S�— 7.3-2 0 v � � O <br /> ADDRES(((S�`O�j G ,c�6 <br /> EMERGENCY/FIRE NUMB / ? ,�/a3 _�S'�j/ ROAD NAME [} Q <br /> " T <br /> n <br /> LEGAL DESCRIPTION (see tax receipt) X )_4) � 1 ' c�_C���I <br /> ` <br /> CONTRACTOR �T �zy-yl��T�D� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORYC STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLINGlGRADINGMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; CorKmercial Business; Bedroom; Deck;etc.) Zv <br /> 0 0 <br /> D <br /> -Z <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 Nort (N). O <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). .°r. <br /> 3. Show dimensions infeet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building t' <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be�(g ed and <br /> dated by the owner. 0 0 <br /> ATE: ILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE_&PERMIT CAN BE IS UED. <br /> I/ c <br /> P ) LAN — — o a <br /> r10 <br /> 3 <br /> ~ d <br /> O ti <br /> >�0 v <br /> I p I <br /> ,! A m <br /> =g,� <br /> ITI <br /> o C� g� � <br /> 1. DRIVEWAY MUST ET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a <br /> 2. REMOVAL OR TTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N '�T' m <br /> o : : B <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- «�m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that 1 his infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o�$ <br /> further accept all liability which maybe a result of the County of Burnett relying on this information providing in this ap- <br /> plication.I re Yo permit countyitifficials charged with administering county ordinances or othe aut odzed person to have O N o <br /> access to t r mixes at any reasonable time for the purpose of inspection. ' p1 m - <br /> m 3o g <br /> SIGN HER M <br /> i tur of own ilding contractor) (date) P■ <br /> rJ <br /> ZONING ADMINISTRATOR <br /> 000g mp <br /> TOWNSHIP PER ITS MAY BE REQUIRED 00 u u mr <br /> a x x x <br /> 0 <br />