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Oy I c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'a o , ' <br /> - 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ,11 <br /> �, 1 <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 C% <br /> regulations of the State of Wisconsin. w m J J) <br /> OWNER Cp r ra 11 `fi re I I r 7-Q l TELEPHONE �1�� G� .3 S`"� -7 3 6-3 � jj f <br /> no00 LOQ r\ " nC f <br /> C' $-9SpoADDRESS 2 Y <br /> EMERGENCY/FIRE NUMBER ��� ROAD NAME �Qh Lo i •e <br /> 1 I J <br /> LEGAL DESCRIPTION (see tax receipt) ,5 "V L 5 y .,�(/w y Sec <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> T� c�i Lf <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o <br /> 0 ^ <br /> o H r <br /> STRUCTURE/ADDITION USE: D•QCk <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o p <br /> 0 <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 dreinfield (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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1 o w <br /> PLOT PLAN0c ` <br /> � a <br /> w y <br /> y pNp <br /> O <br /> IIS <br /> O t� <br /> o <br /> j <br /> O •y <br /> - <br /> Z <br /> G <br /> go Mo <br /> CONDITIONS OF PERMIT: v 3;: C ga Ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z a � ` %'z <br /> o f ' ? <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. �q' : . o 0 <br /> 5i <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 informa- ' »m E m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- i B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I arrl providing in this ap• N u <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N o E <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> n b i <br /> tic <br /> �2ti� h1 � Q 3- may- 9vr <br /> SIGN HERE � <br /> (signature of owner or building contractor) <br /> date) ZJ » <br /> ZONING ADMINISTRATOR irh l"Ha7�1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 8 8 5 8 y <br /> 0 <br />