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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> S <br /> TO THE ZOMNG 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 requirements of the m �U <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> N � <br /> C <br /> 0 Q <br /> OWNER "Te SSC' ..S� J�Pr TELEPHONE 41� <br /> ADDRESS <br /> �31� 77 �b�t4ert`Te G4 . :c d• sIle// L.Al,re <br /> l <br /> EMERGENCY/FIRE NUMBER �. 3 �O 7 7 ROAD NAME 1000 L4 e T-1'e L - <br /> _;J <br /> LEGAL DESCRIPTION (see tax receipt) <br /> ( <br /> CONTRACTOR _j'PS Se <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n GJ <br /> SANITARY PRIVY FILLING/GRADIyG CAMPING UNIT SUBDIVISION o ° <br /> LZ` �if'�J /lE rL�Q o r <br /> STRUCTURE/ADDITION USE: ���.�, L�v�1t�L>7� ° <br /> ,�(Home abin;Commercial Business;Bedroom;Deck;etc.) Z (� <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). <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,(c)building <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 <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 5 m <br /> 7 it z Q <br /> PLOT PLAN ��}IU,! A(ZQ� �1Z/11 p a <br /> r_ In t <br /> 7 <br /> �c <br /> t _ <br /> N <br /> � m <br /> I It <br /> v ' N <br /> _ — f <br /> CoawV C04d f <br /> 11 Tc'W� f m <br /> 6 <br /> CONDITIONS OF PERMIT: o 0 g� a e m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F- oi <br /> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. `„ ; _ 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1 mi I O m <br /> J <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <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 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i. o is p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I e <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 Q N <br /> access to the above described premises at any reasonable time for the purpose of inspection. ,13 'oo <br /> 4 : o A N <br /> QI <br /> SIGN HERE <br /> (signature of ow or building contractor) (date) o x p p <br /> ZONING ADMINISTRATOR �) •11 Arl <br /> TOWNSHIP PERMITS`MAY BE REQUIRED 'o u «� m <br /> NN (.� NNNpN <br /> 0 0 0 0 0 0 0 8 rn <br /> 1 WO <br />