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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator of o� o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 <br /> regulations of the State of Wisconsin. w m <br /> OWNER .10A.) �Ove07Ny d. N,d43 r/UX FLEPHONE 6/Z 26 '7 0- <br /> ADDRESS 6Lzf0 <br /> n D <br /> y7 \ <br /> EMERGENCY/FIRE NUMBER ROAD NAME�'�AOt-f'3 LN/�-E /cu�00 <br /> LEGAL DESCRIPTION (see tax receipt) [sn u''T- La 7 3 SEG D io ti 8 TO N.AiiNi� Q/ ,Va,Gp,!/ <br /> Kn7.uGE /S h�6xf Tri w.� Gi Sw/so <br /> CONTRACTOR DwAl&At <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> /�/.,,� 0 <br /> ��f k 3a' lJt� Rr�ep <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 ° <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 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 s(gned and 9 <br /> dated by the owner. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on c rn <br /> in . C <br /> PLOT PLAN o a <br /> m o <br /> 52 <br /> m <br /> a <br /> c� <br /> o <br /> w <br /> 2 <br /> X <br /> CONDITIONS OF PERMIT: <br /> o m < : Z m o 2 � 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Fo <br /> T� a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ ^' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m C <br /> M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o rtt <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 O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <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 u, <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 <br /> M 3 A <br /> SIGN HERE <br /> (signature of owner qr building contractor) (date) € [ s € [ <br /> ZONING ADMINISTRATOR <br /> N: <br /> m <br /> TOWNSHIP PERMITS MAY BE REOUIRED ^N ^`'`= ("� " <br /> tIINON000 <br /> 8888888 $ rmn <br />