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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w ; _0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> a <br /> TO THE,ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M C _ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and o <br /> regulations of the State of Wisconsin. y <br /> w m <br /> c <br /> OWNER'-, 0 <br /> � ! ffeTELEPHONE �) AiF7zf' <br /> ADDRESS A <br /> Zca Vl/Z�✓ �?���IJOVU) ��1/ !�-'IE%L�JI C� Y L f AJ�7�/ A� yt <br /> EMERGENCY/FIRE NUMBER 7Cj L]'c; ROAD NAME PAV <br /> J <br /> LEGAL DESCRIPTION (see tax receipt) I <br /> CONTRACTOR <br /> TYPE O IT S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 6 <br /> 0 r. <br /> STRUCTURE/ADDITION USE: o 2 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building fir,\ <br /> measurement to the ordinary high water mark of lake, stream, or river. kJ <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In a N <br /> c <br /> PLOT PLAN o a <br /> M O o� <br /> P SCI 0_TRRIJ <br /> a <br /> M c� <br /> I � <br /> d <br /> N <br /> N <br /> n_ <br /> 0 <br /> J <br /> n <br /> N <br /> O <br /> J ' <br /> J <br /> m <br /> O <br /> V <br /> V <br /> Z <br /> 1 � <br /> 3 r� a� '9 <br /> CONDITIONS OF PERMIT: <br /> 0 S. 2 <br /> LO. C6 j rp <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m' 9Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o y y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 m <br /> a IF C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �' a $ '. 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 /> o ; <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 ptrmit county officials charged with administering county ordinances or other authorized person to have aO N p <br /> access to theve dlscribed premises at any reasonable time for the purpose of inspection. N b m <br /> m ` a A 0 i <br /> m m <br /> SIGN HERE D\ <br /> (signature 16f owner or buil <br /> 1 <br /> ZONING ADMINISTRATORJUN �14 <br /> E $ <br /> i� w e.mwwT <br /> TOWNSHIP PE MITS MAY BE REQUIRE N N g N <br /> 0 o p p m <br /> .___._ .. _. .. , oomo00 CA <br />