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O / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descg9i ibed and w ° CIO <br /> located as shown heroin. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the flaws and <br /> regulations Of the state of Wisconsin. o <br /> I w m S <br /> A '( / c m � <br /> OWNER /,� G e TELEPHONE 6 S3 — h O <br /> I!�` Ir����CCC IU O ° <br /> ADDRESS Z 3 OCr/O O� / �7 S- <br /> T- J i <br /> EMERGENCY/FIRE NUMBER Z'3� r l Q ROAD NAME <br /> T 1 a <br /> LEGAL DESCRIPTION (see tax receipt) S LJ n 2-..., � 3� � <br /> CONTRACTOR \ �� f <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDRIONT r) o <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> - ° <br /> STRUCTURE/ADDITION USE: r- <br /> 0 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> o ° <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 3 <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be slned and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED 11o m <br /> PLOT PLAN a Z c <br /> I m o <br /> C o <br /> I m � <br /> III � Im <br /> 1 <br /> J <br /> W <br /> C o <br /> II 0 IIv' <br /> o <br /> I o <br /> I w <br /> ti <br /> n_ W <br /> I <br /> Z <br /> I � <br /> III <br /> i <br /> III e9 O.C N r cDi D O M <br /> CONDITIONS OF PERMIT: o g� bi n <br /> � zcg8 8: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 600 DAYS OF PERMIT ISSUANCE. c f 5.�� �Q =i <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. - �' i i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that t is infor- m <br /> motion 1 am providing will be relied u y g <br /> P g upon by the Count of Burnett Wisconsin in determinin whether to iaaue a rmil. I $'$ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i this ap- <br /> plfcatbn.1 agree to permit county officials charged with administering county ordinances or other authorized perso to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN MERE <br /> M 3 E <br /> (signature of ow r bu n co ractoq <br /> (date) <br /> i i E <br /> ZONING ADMINISTRATOR 8'' <br /> $i <br /> TOWNSHIP PERMITS MAY BE REQUIREDrn <br /> m <br /> + 88�8888umi <br />