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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator l in m c <br /> APPLICATION FOR — LAND USE — PERMITS f <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements 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 Statoxf Wisconsin. 2 <br /> m <br /> �.2 i /�� <br /> OWNER .yyn TELEPHONE / <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER V ROAD NAME <br /> ,,pper� w <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR [^ / /, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> � L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <_ <br /> STRUCTURE/ADDITION USE: � Pee/v � oa 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z _ <br /> o <br /> m ((� <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). r- <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. 0 <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. c 14 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 314111 . <br /> 3 y <br /> PLOT PLAN o a <br /> C oC <br /> I <br /> M <br /> /t nn11 <br /> �—C�✓4��l`vr.. v� 'PP fpm i� <br /> _ � <br /> xAfl — <br /> � � <br /> Cu��a,t1- Gvu� �� ll <br /> p , <br /> Loo <br /> (n r � .0 � <br /> A �' n y '- nm ag m <br /> CONDITIONS OF PERMIT: ^ g• Z a o 0.23 T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zoo a -� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P J i <br /> = cv1 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. [ I"n L) - ? m <br /> a c <br /> J: g ate ; C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m m <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `— m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I 8 <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 <br /> s: <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' <br /> v A a <br /> SIGN HERE <br /> (s' at owner or b contractor) (date) ? 8 ; a <br /> c:� 8at <br /> ZONING ADMINISTRATOR <br /> C i3i"�fu"` m <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N v N O O m <br /> $ 8888888rn <br />