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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o " a <br /> '- <br /> APPLICATION FOR — LAND USE — PERMITS m 3o � <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 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n (� <br /> regulations of the State of Wisconsin. <br /> TELEPHONE <br /> OWNER <br /> / <br /> ADDRESS ZyI 4- <br /> EMERGENCY/FIRE NUMBER <br /> GEMERGENCY/FIRENUMBER <br /> m <br /> ,1 <br /> m <br /> �• ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> •{. Lf O /� i0��7, �W- <br /> „m <br /> Lfl % <br /> CONTRACTOR � 2n o IS2Ct-' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION q ,—^o <br /> n 0 V <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: {/�/c-fly �},y�j/J� � o a (V <br /> (Home/Cabin;`Commercial Business;Bedroom;Deck;etc.) Z (� <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 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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o y <br /> PLOT PLAN �/'� .�� {J)�+� } qY✓/'• �r o n <br /> 5S <br /> f/r III o <br /> Ira I <br /> M <br /> f <br /> w <br /> c z3 <br /> N <br /> M <br /> m <br /> {p tie r' o <br /> y H <br /> er <br /> Iv <br /> z <br /> 5r <br /> L.rye <br /> D NN mfnr D N D V m <br /> CONDITIONS OF PERMIT. v m < m c H o S 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o ? T'z <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. : G .°. C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edgeand belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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- <br /> plication. I agree to permit county officials cherged with administering county ordinances or other authorized person to have N <br /> access to the above described premises otlany reasoni timr the purpose of inspection. m 8 <br /> m 3 <br /> SIGN HERE / .i(� '✓f" -717-71(74 <br /> (signature o owne. r buildi n r t ( t h: a <br /> o ? : <br /> ZONING ADMINISTRATOR ` I $ I <br /> w ' <br /> TOWNSHIP PE MITS MAY BE REQUIRED ,�UL 3 O 1992 In <br /> 88888888in <br /> i <br />