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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and .2 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m nl <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. H m <br /> N v <br /> C <br /> 4 <br /> OWNEUM APP ° <br /> R TELEPHONE o <br /> ADDRESS 1 I C • '9-I th ST BLOOM 114 UTO ISI 0 M 0 - SS`I L-J <br /> EMERGENCY/FIRE NUMBER 2A 1 Q ROAD NAME V f9 K u^� 1l�/. R/� , <br /> LEGAL DESCRIPTION (see tau receipt) D <br /> I � <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT S`UnBB,DDII,V-ISSIION o <br /> STRUCTURE/ADDITION USE.--a' <br /> SE: a <br /> (Home/Cabi ommercial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> a <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 drainfield (DF). 0 <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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 7I 3 N <br /> C <br /> PLOT PLAN n o a <br /> m SU o <br /> C I � <br /> a <br /> M <br /> M <br /> 0 <br /> o <br /> 0 <br /> N <br /> r <br /> Z <br /> I <br /> D WWI? fW r- DDp U <br /> M o C m m o o. F m <br /> m -� Z '2 m a2- 33 <br /> CONDITIONS OF PERMIT: ? N. ,z o 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 �� D <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I in <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m C <br /> $ c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o (4 rDit <br /> edge and belief it is true,correct and complete.1 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 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 S $ m $ <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- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have 90 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ iQ <br /> M [ V A e <br /> m M P <br /> N $ <br /> SIGN HERE .0E <br /> (signatu of owner r uil c or) - (O x <br /> ZONING ADMINISTRATOR ! <br /> TOWNS IP PERMITS MAY BE REQUIRED T �J�7L(�[� <br /> AUG 2 1 �u am ' 888M <br /> `I <br /> $ $ $ <br /> i; <br /> I . i' <br />