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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Um o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Z H <br /> located as shown herein. 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 laws and 3 n <br /> regulations of the State of Wisconsin. o <br /> N 41 <br /> N � <br /> C <br /> OWNER 14&e1.. TELEPHONE n £O <br /> n� �J <br /> ADDRESS a��j l.�// � il/M :5Qid/.� ri(./.{- 91_. Y U 3 m <br /> EMERGENCY/FIRE NUMBER 7 F-5-3 <br /> ROAD NAME Looe <br /> LEGAL DESCRIPTION (see tax receipt) Y� _����,� Tun N R ( 6 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING C� GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION - ° <br /> o <_ <br /> N r <br /> STRUCTURE/ADDITION USE: 0 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> Z o <br /> 0 0 <br /> a <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)buildingto 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 9 <br /> dated by the owner. 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on c N <br /> PL T LANn/ A o <br /> �/ V ) <br /> m o <br /> c l ' <br /> uV m cu I- <br /> Q <br /> a iSo ft <br /> b <br /> Q z <br /> G7 F <br /> (13(1 <br /> mc�wiu �n0 � <br /> am S. <br /> b N <br /> CONDITIONS OF PERMIT: m y. c li i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £0 <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =to 9 <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> 0i i nLT p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : ^: m ig I C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- to ro.n <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 10`$ o <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 pe it ounty officials charged with administering county ordinances or other authorized person to have ct o <br /> access to the above scrippremises at any a onable ti for the purpose of inspection. = m b e <br /> m a oA 0 <br /> N � m p <br /> SIGN HERE <br /> nature of ow bui mg ract rr) D (date) <br /> ' <br /> ^ II s <br /> ZONING ADMINISTRATOR <br /> � �N N W N NDNN <br /> WNSHIP PERMITS MAY BE REQUIRERL <br /> O N U N N N O N <br /> 0 0 0 0 0 0 0 <br />