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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54472 Office of Zoning Administrator c c L <br /> APPLICATION FOR - LAND USE - PERMITS 2 - <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementsof the <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the and <br /> regulations of the State of Wisconsin. m <br /> OWNER �(� IL J �l ��f� TELEPHONE�� i� _ �� Y(i' lI I -� $ E <br /> O � 2 <br /> nn r <br /> ADDRESS ( (r �] I`(%F(-/LLC <br /> EMERGENCY/FIRE NUMBERq'{,J c% ROAD NAME r)(.6 <br /> p-14 va llc � y �� rl3l 5 T-re/R tjo� <br /> LEGAL DESCRIPTION (see tax receipt) 0C. 11 Cl j EC C 3 Q f'(^�(♦'E P 1.VL S 4'T S l '2C l d d r <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o . <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 < <� <br /> T <br /> STRUCTURE/ADDITION USE: 7S C R t FiL, P0 R-C S <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z <br /> o R <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 Norl h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (OF). 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 A <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl;nod and 9 <br /> dated by the owner. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 11 3 <br /> PLOT PLAN SES ESe _ c <br /> ,i-+A-6:I CL Liu � � .I� w <br /> w_4TI jL <br /> --- <br /> 111 <br /> CN � <br /> t r + y y <br /> r <br /> n <br /> Z <br /> `Q S <br /> 5( <br /> A <br /> lir f <br /> R Fgo In <br /> o $ B a In <br /> z XI <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i C <br /> M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �'i '• `• <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best o my knowl- -' ` C <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs. r In <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize thl t this Infor- p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I - $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providln In this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized per n to have, <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> (signature of owner or building contractor T (date) E <br /> ZONING ADMINISTRATOR TOWNSHIP PERMITS MAY BE REQUIRED « . -$' : � ii5 m <br />