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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Administrator c m - o <br /> APPLICATION FOR - LAND USE - PERMITS m _TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c S —� <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 <br /> regulations of the State of Wisconsin. ,� m <br /> m m <br /> a O <br /> OWNER , �� TELEPHONE v E <br /> m_ 19 <br /> ADDRESSin� <br /> f /I <br /> EMERGENCY/FIRE NUMBER `� ROAD NAME L J <br /> LEGAL DESCRIPTION (see tax receipt)J V= le �L// R f VIA/ <br /> ��'/� <br /> A�`"c+ tL/ / 7 <br /> CONTRACTOR [AIM <br /> v� /� /1/wf r Ands <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> _ '. <br /> ,�� � J� y� m r <br /> STRUCTURE/ADDITION USE: .,��(�t'1f� 9 X sd p C'at 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 0 <br /> 0 0' <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) G <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 (�,se tic tank(S�,and drainfield (DF). I o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building .0 <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 21 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 9I v <br /> KECl) <br /> an ' <br /> Z v <br /> PLOT PLAN b/'Lr1 50 <br /> a <br /> C i = <br /> o <br /> X)TT�o <br /> v a Z,: g 9 <br /> CONDITIONS OF PERMIT: < m C B =m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f :itZ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ° = L7 m <br /> g Lr 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 informs- «�m N e m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i 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.I agree to permit county officials charged with administering county ordinances or other authorized person to have n o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 e <br /> N � ' <br /> SIGN MERE AN <br /> '• N E <br /> (ai ure f owner or n contractoq if (date) a' <br /> ZONING ADMINISTRATOR Q <br /> TOWNSHIP PERMWS MAY BE REQUIRED m <br />