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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 — PERMITS3. <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 z <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 Wiscoi isin. <br /> m <br /> OWNER �G S' L Y17N TELEPHONE yE2 m <br /> ADDRESS �� G ( �� -T ( '- <br /> r t� <br /> EMERGENCY/FIRE NUMBER ROAD NAME 3 <br /> LEGAL DESCRIPTION (see tax rete pt)S fr :71-.1 '�. �� L.tr 13 CSM 13 ( /3y O <br /> �... 4 Z- e.am•..T- '715- 32 ' 84L6 <br /> CONTRACTO '4;Bt�iC S--`^o (�1<C 4J4Li„ orNlw 14 <br /> �.ar <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONp a °< <br /> _ S m <br /> STRUCTURE/ADDITION USE: �� b ° $ <br /> Home/Cabin;Commercial Business; Bedroom;Deck;etc.) ^I Z o <br /> � o o <br /> �• a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) N <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> r <br /> 2. Show the location of the w4 01 (W),septic tank (ST), and drainfield (DF). ° <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building 11 <br /> measurement to the ordinarif high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and - 1 l>`1 <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCkTIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a <br /> 11 Z Q <br /> PLOT PLAN <br /> o n <br /> S [. �![t d c—,�y © Plan a I <br /> @.z <br /> m <br /> J <br /> n_ <br /> FQ o <br /> N <br /> V .•�`uJi� � uAc <br /> 3L <br /> r , v <br /> �G <br /> Ac�Wr>a� '9 <br /> m �� ''- ame$ y <br /> �4�LQ _ a m y •zc8 = O ; <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o �'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d, =2 a: M <br /> In <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o �°2 O <br /> I declare that this application(i icluding any accompanying schedule)has been examined by me and to the best of my knowl- : o x C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «r y a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 6 v S g p <br /> mation 1 am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $`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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the a5ave described premises at any reasonable time for the purpose of inspection. T ? 3 i; [w <br /> m V A N i~ <br /> SIGN HERE N. <br /> (ai n re o owner r bui ontnctor) 1 LES �l (date) <br /> { --- <br /> ZONING ADMINISTRATOR ^ J/� 4: <br /> N' x x 'x <br /> (77 HrnH ataax Tl <br /> TOWNSHIP PERMITS AY BE REOUIR�pi t { ? 7 <br /> HEM E�� � � � m <br /> obb ® o <br /> 0 <br />