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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <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 � H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. y <br /> O (—/ <br /> OWNER I r K p; , TELEPHONEry I � QQ J � o �O <br /> ADDRESS /'�Ut,(�"�\1�1'Pil� <br /> EMERGENCY//FIRE NUMBER Oy r"i ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) P a I❑„`V.�+ r e, �qI n�� _R1�IGr /w r� �a+ i <br /> CONTRACTOR (,UC. (7, b.`J�.N ._ J JQ F-lJ L,^ Ames <br /> TYPE OF PERMIT(S): DWELLING/BUILDING. GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION — 0 <br /> ,�r/�� i I 1 `/ G 0 <br /> STRUCTURE/ADDITION USE' 10 uj C.�(,t(K$ //']ore- �� �� D I uj1P 1 7 jo, I rr,� o = <br /> (Home/Cabin;ComrrWrci&l Business; Bedroom;Deck;etc.) Z 1? <br /> 0 0 <br /> m <br /> } <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). <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 X <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 y <br /> PLOT PLAN Z <br /> 0 o a <br /> n <br /> r m o <br /> C G1 <br /> m � r <br /> oe <br /> it <br /> Q) <br /> V' A <br /> O <br /> ` o <br /> 07 <br /> ` a <br /> b 31 <br /> n1ur�.. <br /> m <br /> CONDITIONS OF PERMIT: <br /> C 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F `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. - o i i C)g i mm <br /> aEi <br /> PP (including Yaccompanying 1 Y Y <br /> I declare that this application mcludin an schedule has been examined b me and to the best of m knowl- o: � � C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- i i a w h In <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- �i8 it p <br /> mation I 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 ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have 0” p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 0 <br /> v <br /> 0 . <br /> SIGN HERE <br /> (sig to o own wilding contractor) (date) <br /> ZONING ADMINISTRATOR $ f <br /> TOWNSHIP PERMITS MAY BE REQUIRED d O 6 N N N N p N T <br /> 6000 $ 0 $ $ <br /> 0000 <br />