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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54672 Office of Zoning Administrator (14 m E c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m o (� <br /> ag by application for a Permit for the work described and I <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementof the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with I other applicable County Ordinances and the laws and Q/ <br /> regulations of State of lawn m m <br /> non ni�n <br /> OWNER n TELEPHONE ' u f <br /> O = <br /> m � <br /> ADDRESS <br /> PD- 2y <br /> i <br /> EMERGENCY/FIRE NUMBER _756T <br /> ROAD NAME Ccn+er a. <br /> LEGAL DESCRIPTION (see tax receipt) Qi I St Acyl UU <br /> CONTRACTOR �!)&w <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> r <br /> STRUCTURE/ADDITION USE: r o <br /> (Home/Cabin;Commercial Business; edroom;Deck;etc.) z o <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <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 (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o <br /> KEto <br /> v o n <br /> PLOT PLAN ?F-9- Sj m <br /> Setback from Center Stre C I = <br /> / � needs to be 63 feet from <br /> �0E centerline. S M <br /> I � IO <br /> / b <br /> Jy� <br /> _ <br /> m <br /> O y <br /> w � � <br /> k0F_� <br /> Z <br /> Setback from rear of line <br /> F I needs to be 40 fee or <br /> greater. <br /> �--- ly <br /> m <br /> CONDITIONS OF PERMIT: m g Q Is = 2' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 1JQ : <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. ` �" ` Gt In <br /> e O <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.1 acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ B p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1 . <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 pe n to have C.): m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m m i <br /> � N <br /> w <br /> SIGN HE Nh <br /> (signature of owner or ilding con r toq <br /> ZONING ADMINISTRATOR g ` <br /> esu Min <br /> TOWNSHIP PERMITS MAY BE REQUIRED � i5 ti- Mn <br /> 88888 T <br />