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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator i - o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO`THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and is <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require nts of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and themelaws and <br /> regulations of the State of Wisconsin. <br /> oc4 O <br /> OWNER SSM SORENsonl TELEPHONE O <br /> l u (J £ <br /> ADDRESS 7'�oo j W SyR�l3 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: r- <br /> 0 o g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) L <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 (N),septic tank (ST), and drainfleld (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 (86 <br /> measurement to the ordinary high water mark of lake,stream, or river. lis <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 1 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 3 <br /> N <br /> PLOT PLAN <br /> A o n <br /> o' <br /> VV <br /> 1 <br /> q rn <br /> o <br /> 1 , <br /> 0. I S <br /> m <br /> 4 � <br /> N <br /> wry <br /> ]�J Z <br /> I f <br /> Lm <br /> ne <br /> CONDITIONS OF PERMIT: 13XI <br /> Z cg g� � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m 6': �.z .� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f 1 c <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. f'ir ` Og i m <br /> S ': O <br /> I? t <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ? � � 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- — w r. a <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this informs- <br /> E B ,�' ? m <br /> motion 1 am providing will be relied u G <br /> D p upon by the County of Burnett Wisconsin in determining whether to issue a permit. 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 administeringcount ordinances or other authorized <br /> Y peroon to have <br /> access to the above described premises at any reasonable time for the purpose of ins 0: o_ _ <br /> f � m <br /> SIGN HERE <br /> ow <br /> ZONING ADMINISTRATORmnc + (d3 '199 <br /> NOVY J.7ri <br /> TOWNSHI PERMITS MAY BE REQUIRED, "-- -- J 'e N «««� •n <br /> uiSUa �fSIn <br /> 1. ------ 8888888 vmi <br />