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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 — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the $ , <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. u o <br /> rJfFY�4 ��� 7f�663� � m <br /> OWNER iJ t7_X/C) J- � �i ./ TELEPHONE D/� OO a EO <br /> 1'"/T <br /> ADDRESS GGT f l SIV42 45 '53 Lf 3 m <br /> EMERGENCY/FIRE NUMBER 8o ROAD NAME CTL EF- <br /> LEGAL DESCRIPTION (see tax receipt) ' S Liu <br /> L. c 3— <br /> CONTRACTOR �� / 1 J .� <br /> L7 I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 3 ADDITION p <br /> aO <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> o < <br /> STRUCTURE/ADDITION USE: I \ .C'J 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) I <br /> 0 0 <br /> v <br /> m <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 Norl h (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)building to center line of road,(cj building .1 <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 M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 91 3 N <br /> PLOT PLAN o n <br /> ill <br /> O <br /> C I �^ <br /> t c <br /> a <br /> 0 N <br /> O <br /> m <br /> O y <br /> w <br /> y Z <br /> l <br /> f <br /> M <br /> so ca �'�aa0 m <br /> Dg� �aG 33 <br /> a m 3.: g <br /> CONDITIONS OF PERMIT: � .z C� NO i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. T'1—rn ' M <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> 9g tei O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- i o l i C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize thatthis infor- 8 l G <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ <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- i i ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the above d"ribgVremises at any reasonable time for the purpose of inspection. <br /> mm m m : <br /> SIGN HERE <br /> Vrlfbnature Qf owner <br /> roor building contractor) (date) rX <br /> ZONING ADMINISTRATOR <br /> [ ww� wNa T <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 $ N 5 m <br /> 8 $ $ 8 $ M <br />