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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o Z <br /> APPLICATION FOR - LAND USE - PERMITS <br /> 3 _. <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 n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. — o <br /> w m <br /> w � <br /> c <br /> OWNER 391 1 4T E 'zNv�e lxTS2ELEFP-HIGO-N-EMtctAP.E!_ <br /> ADDRESS 7744z" rsf <br /> Mry _7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME N LAKE r <br /> LEGAL DESCRIPTION (seetaxreceipt) n <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ✓ ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> o <br /> Yl�r-tr (JK )//L w r <br /> STRUCTURE/ADDITION USE: <br /> r0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <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). o <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)building to 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 9 <br /> dated by the owner. O O <br /> 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. N <br /> PLOT PLAN o a <br /> m �t� <br /> L. C L 1 ' <br /> 0 N <br /> M <br /> T ❑ a <br /> 55t aS0/ 0 <br /> O <br /> J <br /> I <br /> m <br /> O <br /> N <br /> N z <br /> i <br /> {� eJm � tnr D Dp V <br /> a'� °' 4. m a m a <br /> T. D <br /> CONDITIONS OF PERMIT: v m < ' m C m o_ M <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? ,n'2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ , : m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 62 O <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 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- — ' !m 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. I 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 N <br /> access to the above described premises at any reasonable time for the purpose of inspection. i j <br /> 3 <br /> T <br /> m <br /> SIGN HERE <br /> w : n <br /> (signature of owner or ilding conrector) (date) <br /> o <br /> ZONING ADMINISTRATOR 1111 l �i FiR1l/ g <br /> fn <br /> ' 6)61 69 fR N T <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N u o " o o $' m <br /> 888888 $ 8ai <br />