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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator —`rn " / -'6 1 Z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m 3 ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w ° (5'- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m CR <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a DO <br /> regulations of the State of Wisconsin. o <br /> w m <br /> w � <br /> OWNER ^ � ^< �CIf , E. T _,)In TELEPHONE &(7 <br /> 3a sy 3 3 � �^ n �f <br /> ADDRESS <br /> 3C X ✓ u .4 A iv/' <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' t <br /> LEGAL DESCRIPTION (see tax receipt) i <br /> � e7 r� Niclyyt S ' c 3o T w/n/ rG ! l3uR �t7r �a <br /> CONTRACTOR <br /> TYPE OF PERMITS): DWELLING/BUILDING �GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY V PRIVY FILLING/GRADING CAMPING UNIT o <br /> SUBDIVISION o' < 111 <br /> 0 <br /> m r <br /> STRUCTURE/ADDITION USE: if�ew ;. B 0 <br /> (Home/Cabin;Comme ial Business;Bedroom;Deck;etc.) z <br /> 0 0 <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p < <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). O <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. 0 O _. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v <br /> PLOT PLAN z o <br /> o a <br /> j M o <br /> � i c I <br /> ,\Ptd m fQ9j U, <br /> r <br /> 1,ytj s <br /> o <br /> < pQ0-N y�f ? 0 <br /> 0 <br /> 95 <br /> 3 z <br /> �01 10110^_ 10 161- <br /> aAw <br /> In <br /> Y <br /> e- <br /> CONDITIONS OF PERMIT: •�:-c Y v m < °i C m o' 9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a ? T� ? --I2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — N ! m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Y'n L7 O <br /> g c' : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o ' I ° '� M <br /> 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- .`d'm N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m 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 50 <br /> ao <br /> access to the ab o d scribed p emises at a y reasonable time for th urpose of inspection. p <br /> m ' ? 8 R <br /> M V m <br /> SIGN HEREk 2— 8 <br /> N : <br /> a : <br /> (at atur owner uilding ntractor) (d"aie) a, ' <br /> ZONING ADM I ISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED II ' ( 101992 o 0 <br />