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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning AdministratorC ; 'o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the `m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ n <br /> regulations of the <br /> a State <br /> of Wisconsin. / , a Vm <br /> O <br /> a\ <br /> OWNER TELEPHONE( 1 � ��y ' 7 o <br /> F <br /> ADDRESS VO � \�- ` 1QJ N Cv`'Ou^'��J1\N I� r`-lnnDSrnl�ilb m 1 S �T'I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> `1 � <br /> LEGAL DESCRIPTION (seetax receipt) I- o+ `y •,v -cam¢ �Iq,` 0'� 1` d• Yko IOLG��bK .yam <br /> fN 5£ tl SEt % 5e-};or✓ (c.•�40- Ib '^ we4-t e-z6r <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o $ <br /> J » <br /> o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> 0 c <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). r <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield (DF). 4 <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAID FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I v w <br /> C <br /> Z v <br /> PLOT PLAN ° n <br /> C ` o <br /> r1 i <a t cH w Eta 0 4 s <br /> (l. tor MAnK It 21�e� �l (C <br /> IN <br /> N � <br /> ui 11 � <br /> g <br /> v , <br /> i N' R O 1 <br /> / `ry <br /> 3 <br /> f I <br /> Lo <br /> u(i is �L X � <br /> o c m m o a F � <br /> —a'4 " rt <br /> no e y <br /> a Z : C a o <br /> CONDITIONS OF PERMIT: < a u o . 03 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ 5 �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M i <br /> = c� E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Iii i j rn <br /> gl <br /> m c' <br /> C <br /> 1 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• yy!� <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ri o G <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I S u 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. ° ' e e ' <br /> E 38x[ <br /> A <br /> 8 <br /> SIGN HERE <br /> (a gn of owns building contractor) <br /> 8 . e <br /> C t P;i 0 : <br /> ZONING ADMINISTRATOR <br /> ~ NN n <br /> AP <br /> TOWNSHIP PERMITS MAY BE REQUIRED R I fi o ,'o m <br /> �� - 88888888 rn <br />