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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator `-m � ✓ o <br /> APPLICATION FOR — LAND USE — PERMITSTO 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 m <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. <br /> N � <br /> OWNER 7 TELEPHONE <br /> n O <br /> EFF'c'a:Y f t/RJ}Zr!'�C£}C.� 12 922 e�L/L <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER r -/ ROAD NAME CtCA/f ,�, Y �ey&b <br /> (,C l v <br /> LEGAL DESCRIPTION (see tax receipt) LOY Iy Ce.676/< I/' 1-<K6'5 .9 <br /> CONTRACTOR S'fLF <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ) ADDITION v <br /> 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> /�_ _ -6� N <br /> STRUCTURE/ADDITION USE: �,�F+K/-1 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Za (� <br /> O o <br /> a <br /> o <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). g <br /> 3. Show dimensions in feet of the following:(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. 0 <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. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a y <br /> 71 Z Q <br /> PLOT PLAN 0 <br /> A s <br /> C 1 <br /> i <br /> 0 <br /> N <br /> A <br /> O <br /> 0 <br /> N <br /> O <br /> J <br /> i0 <br /> l7 y <br /> N ^ IL <br /> Z <br /> 1 <br /> C <br /> CONDITIONS OF PERMIT: < m' .2 c 8 .0 ro T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m 5 fir' j <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'No O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- J o C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- E «w n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> mation 1 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 so- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. [ 3 $ <br /> 9 ry�f m m 0 : <br /> SIGN HERE I" _ 9 "3 o <br /> .8 <br /> " nature of owner or building contractod ( 7�-! E E �' t �. <br /> ZONING ADMINI AOR <br /> www�'wt�w� �I <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N N N N 8 t m <br /> $ $ $ $ $ $ $ $ N <br />