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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,y, 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 'o $ <br /> Burnett County Land Use Ordinance, nation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin\ .rSov� C )1 S� o�Scj- 3�j�1(o O H m <br /> Q a p m m o <br /> OWNER 0� Q.L� " (� .�'l\�C� TELEPHONE C—I\S� ,S l-3(Q�Q L( <br /> �l3- <br /> ADDRESS 3��5 O <br /> EMERGENCY/FIRE NUMBER ���JCJO <br /> ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 1� O <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 °- <br /> VV� Y o <br /> STRUCTURE/ADDITION USE: �-� <br /> (Home/Cabin;Commercial Business; edroom; Deck;etc.) o a <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I C� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). r <br /> 2. Show the location of the well (N),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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v <br /> Z c <br /> PLOT PLAN A c <br /> C � <br /> N <br /> s <br /> 1 � <br /> 0 <br /> m <br /> .. I <br /> Z <br /> I <br /> fnsf�l �-l3—�`i a <br /> 3D oF � sti'J <br /> A = <br /> rDDFrin <br /> � <br /> eAZ� r; ° p <br /> QCSNO M <br /> CONDITIONS O P MIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. N' � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c"' ; m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> i O : rn <br /> C <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 informa- I e'm"' fit <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 81 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. -nE I <br /> Y <br /> SIGN HERE �\ <br /> (signatureowner r Dulldinq Contractor) <br /> ZONING ADMINISTRATOR <br /> -M <br /> TOWNSHIP PERMITS MAY BE REGUIRED ` SEP 13 X994 I <br /> 818 y <br /> 88 8 8 8 8' <br />