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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> s <br /> TO T+iE 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 requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. H m v <br /> OWNER /. �j7T ©� C, /'� TELEPHONE <br /> J <br /> w^/ y 7 0 CJ /J /�s ,, /� <br /> ADDRESS 50moW ✓)�L�/F� 07 <br /> i <br /> EMERGENCY/FIRE NUMBER 1"/.'1 S/ ROAD NAME /.�I \/ 7 -yam-- <br /> J r0 tel/ 7 ` I , <br /> LEGAL DESCRIPTION (see tax receipt) J—o�t I � CSM Vol 3 , p yt 01/(o <br /> �J l <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLINGG//BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/ bin;tommercial B iness;Bedroom;Deck;etc.) Z a <br /> 0 0 <br /> m <br /> 3 <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 drainfieid (DF). <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building 1f <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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o N <br /> 11 Z v <br /> PLOT PLAN <br /> o n <br /> Seg Pv y <br /> C, <br /> ' c <br /> ° o <br /> oo <br /> c <br /> IN <br /> Ir <br /> N <br /> 1 Z <br /> Z <br /> G <br /> 0 c m n' Da M <br /> m. a nN `i `tea <br /> CONDITIONS OF PERMIT: <. a. i '� m o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o FT� a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = t^ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, O <br /> 8 : nom ` c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g 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- O <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. 1 $ <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 . <br /> access to the above describ premises at any re n ble ti a for the purpose of inspection. 3 <br /> m m <br /> -yam a <br /> SIGN HERE -P- <br /> (si at owne it i contractor) (date) x <br /> o : <br /> al <br /> ZONING ADMINISTRATOR 8 <br /> H : <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 �� " <br /> dN N NON O O O m <br /> 88888 $ $ 8w <br />