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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 } (� `} of o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. w <br /> OWNERJEF RBArsonl TELEPHONE u - ' n V £O <br /> ADDRESS 17ll _5 ILIk/R7ZR,L"'oA/ OS� <br /> EMERGENCY/FIRE NUM BER ROAD NAME -FR(--MSTEgf) LK ;o- <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Naf7J R 1 <br /> D L <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> c1 <br /> SANITARY PRIVY FILLING/GRADING CAMPI UNIT SUBDIVIS N ° <br /> STRUCTURE/ADDITION USE: S66r — �(Jlt,f I (T) r o <br /> (Home/Cabin;CoInmer&al Business;Bedroom;Deck;etc.) <br /> 0 00 <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) J <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 drainfleld (DF). o <br /> 3. Show dimensions in feet of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building <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 signed and X <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 <br /> c <br /> PLOT PLAN o a <br /> d <br /> m o.— <br /> c <br /> �i <br /> 0 <br /> ° <br /> o <br /> m <br /> Z <br /> Z <br /> ( <br /> S� V1 Z' g D W m o �. mma m <br /> m °w °a m <br /> CONDITIONS OF PERMIT: ? m cm o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0i ? ? M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = N i m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C'4 �^ ' <br /> m c i C <br /> g : a , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m m <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- i�,o N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 m 8 <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- in <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O u o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 T <br /> Am <br /> n <br /> SIGN HERE 4� "Yrj Z? <br /> (signature of owner or building contractor) � I ' (date) <br /> s : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIR61'I 1992 `� ` �(/�,, M <br /> U N N O O O m <br /> 88 8999m <br />