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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 4 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 descrirr,���bTbTbT��VIII and m G <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the Is s and <br /> 0 <br /> regulations of the State of Wisconsin. c m <br /> O o <br /> OWNER p TELEPHONE�� y,���•���6 �—1 —?- <br /> 73J <br /> $ � O A <br /> ADDRESS C, N 3 S -o(C. oc" r •/ U,U /-� 1 USS'�:'*+ h <br /> EMERGENCY/FIRE NUMBER 0 No <br /> ROAD NAME��c / e r �- <br /> LEGAL DESCRIPTION (see tax receipt) �. 7 ? O N <br /> CONTRACTOR <br /> w�-r (sem <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT� SUBDIVISION <br /> v _ o � <br /> STRUCTURE/ADDITION USE: I , v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0° <br /> } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) '1 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). e <br /> 2. Show the location of the well (W),septic tank(ST),and drainflaid (DF). I <br /> 3. Show dimensions Infest of thefollowing:(a)buildingtoall lot lines,(b)buildingtocenter lineofroad,(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 all;ned and <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSnE VERIFICATION BEFORE A PERMIT CAN BE UED. Z n <br /> PLOT PLAN c o <br /> - I <br /> 0/- 111 U� n <br /> &I — I <br /> ` J <br /> ch <br /> 7 <br /> Z � <br /> X4 QAJETF/C AJ ° <br /> yin 6n s -- �'' �,J if r`4- ) <br /> a v Isom <br /> c 8-' r. <br /> CO�1B IONS OF PERMIT: ? S QZ : 1 <br /> Z m ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 600 DAYS OF PERMIT ISSUANCE. o f o �� cc = <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r Im <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O ` <br /> i in <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best A my knowl- o <br /> edge end belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informs- <br /> tion contained in thin application(including any accompanying schedule)and I further declare that I recognize t at 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 $� 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this infonnatlon 1 am providi gin this ap- <br /> plication.I agree to permit county officials charged with administering county Ordinances or other authorized raon to have Ro <br /> access to the above premises et any roaeoinable time for the purpose of inspection. T ' 9(- <br /> i [ <br /> SIGN HERE - ! -A� <br /> dda .. <br /> (sl at of o or building contractor) A - - <br /> ZONING MINISTRATOR "�'a y,�„j' •n <br /> SSN Nd m <br /> TOWNSHIP PERMITS MAY BE REQUIRED s m <br /> I <br />