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Burnett County 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Administrator m o -. 0 <br /> APPLICATION FOR - LAND USE - PERMITS . f <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require ms of the m c r- <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and th laws and 0 $ <br /> regulations of the State of Wisconsin. — o <br /> m <br /> m <br /> C <br /> OWNER elfO, d, /' ru ' Le r, TELEPHONE CE tZ� C-)Z3 y3� a = <br /> V (1, J -/-, / , m O <br /> ADDRESS 6 lJ l `I Z,�--N S/4r ZJ ✓ ...> A/ ---/ .Z m r CC <br /> EMERGENCY/FIRE NUMBER ROADNAME �f�rrl / k� I <br /> LEGAL DESCRIPTION (see tax receipt) Z q Zgl/V Z 5 U 1/uv 3&/73c ,Cit '('1��,(/ y <br /> CONTRACTOR <br /> I-11 F_ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURES ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE <br /> (Home abin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 0 <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 No h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (DF). o <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c I building .1 <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and 9 <br /> dated by the owner. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE USD. on 3 N <br /> On c <br /> PLOT PLAN Z <br /> M <br /> C <br /> m w <br /> 7=- <br /> cl- <br /> Cc) � �, � � rL (. <br /> t� <br /> _ <br /> 00 <br /> r <br /> r� /'7 5V o <br /> Z <br /> J n <br /> dee hre vl IN <br /> m ii c-m_ rD>C -0 <br /> M <br /> CONDITIONS OF PERMIT: c �.� C g m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 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. ! r^ ' O m <br /> 10 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- N ro N m <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 g� $ <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 O i p <br /> access to the alw described promises at any reasonable time for the purpose of inspection. m <br /> m ' i a <br /> m e : <br /> SIGN HERE u <br /> S S <br /> N <br /> (signature of owner or building contractor) (date) '�T <br /> ZONING ADMINISTRATOR <br /> Zt <br /> TOWNSHIP PERMITS MAY BE REQUIRED w MN N NMN+» <br /> o ,ei " �NN .vNr,x' m <br /> 88888888 ai <br />