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Burnett county 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 o <br /> regulations of the State of Wisconsin. m <br /> C <br /> n O <br /> OWNER 1/r]NLE�� TELEPHONE <br /> ADDRESS C7n illi ( Q m m <br /> 9332 sgiGGs Av . LExiolsmwI MIJ- SSol,4 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME _ ]4 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION V- o <br /> `y,, n S7 <br /> SANITARY /\ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION °_ �- <br /> o m <br /> o l" <br /> STRUCTURE/ADDITION USE: g <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o 0 <br /> �} 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Irk <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). SU <br /> 3. Show dimensions infeet of thefollowing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building 10 IZ <br /> measurement to the ordinary high water mark of lake, stream, or river. DO <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o N <br /> 1A c <br /> Z o <br /> PLOT PLAN n o a <br /> � N <br /> c I � <br /> In � <br /> w <br /> I <br /> O <br /> 0 0 <br /> I� <br /> N_ <br /> n I� <br /> Z <br /> l IDN'' <br /> _ 1 <br /> m —g� am a = <br /> CONDITIONS OF PERMIT: ^ < _': Z C 8 gra' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E T`z : -f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. P' I L7 m <br /> g' m 6 C_ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- � 0 . : <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs. H y ui <br /> tion Contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I v o 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- d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to haveo <br /> c1 a o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 0 ' <br /> m m A N <br /> SIGN HERE I-: <br /> (signal e o net uildl tractor) ldatf), <br /> � ' // o E <br /> OrT <br /> ZONING ADMINISTRATOR - [ <br /> WNSHIP PERMITS MAY BE REOUIRED �� N N <br /> T <br /> " 000 oo $ oM <br />