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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Z <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n I GC <br /> regulations of the State of Wisconsin. = o — <br /> m 9t _ <br /> ^� \'� p 1 m <br /> OWNER YJ� �BrQ 1\ _� ' TELEPHONE % q Q(1d /ry/ rlj a .,rl \ a f <br /> E'e. eJe<<or� obq 7�l `(fQt `I 17Y / <br /> (� _ . <br /> ADDRESS 1 D Ir�� / (�L I_ s� rt, r '�", Sy Q � 0 <br /> EMERGENCY/FIRE NUMBER • '�51�1/ fJ ROAD NAME —1�—,��� <br /> LEGAL DESCRIPTION (see tax receipt) n (-M �0l S <br /> o Il Q �-+✓ 3 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> o <br /> s • _ <br /> STRUCTURE/ADDITION USE: —'���P $ ° <br /> (Home/C in; ommercial Bus' s;Bedroom; Deck;etc.) Z <br /> O a n <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 (D17. <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. Q <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. 1I o 0 <br /> c <br /> PLOT PLAN o n <br /> mSJ <br /> I N <br /> V W <br /> O <br /> J <br /> O <br /> J <br /> O <br /> u <br /> Z <br /> I y <br /> o c -° m m n a f m <br /> m N a '= D <br /> CONDITIONS OF PERMIT: `° < : ,2 o ro <br /> I. 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. M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : mC <br /> i Q @ l <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- Q 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. <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 8 g <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 O . p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ B <br /> T 3 <br /> M � N <br /> A <br /> SIGN HERALA Ad Al' <br /> E H a <br /> (siETOWNSHIP <br /> owne or ilding contractor) -( ate) [ [ <br /> o : <br /> ZONING ADMINISTRATOR PERMITS MAY BE REQUIRED <br /> QMrn ut u, o <noo � m <br /> N <br />