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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 <br /> 5. f <br /> APPLICATION FOR — LAND USE — PERMITS <br /> o � <br /> TO THE ZONING AbMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 v r <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremei its of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State <br /> H� State of WOisDconsin. m <br /> O <br /> OWNER Yogi" / j TELEPHONE617 6 1�05,7 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER Z RD 7 5" ROAD NAMEat ct- <br /> LEGAL DESCRIPTION (see tax receipt) &01- Z 6"T; Z T 40 IJ ae Cr�V <br /> CONTRACTORM G W Ls/Z._ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING Z GARAGE/ACCESSORY STRUCTURE ADDITION 0 11 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> y » <br /> STRUCTURE/ADDITION USE: ° <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o <br /> m <br /> 3 q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) v `J <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate Not th (N). C' <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). a o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,( )building yl <br /> measurement to the ordinary high water mark of lake,stream, or river. Q v <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. C c -� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o sn <br /> PLOT PLAN <br /> 0I <br /> � . o <br /> \ N <br /> e � <br /> 7 <br /> I x7 <br /> ISa ^. <br /> 2 <br /> 16.1 n 2 AG. <br /> '— m3. zcggi 3 <br /> CONDITIONS OF PERMR: 0 o ' : •z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn <7 <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 1 <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- R <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> V <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $`� $ ? <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 rson to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> N <br /> SIGN HERE <br /> (signal u f owner or building contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED a' m <br /> Y � <br />