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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54472 Office of Zoning Administrator N . <br /> APPLICATION FOR - LAND USE - PERMITS _ <br /> TO THE ZONING ADMINISTRATOR:The m <br /> undersigned hereby makes application for a Permit for the work described and a ° <br /> located as shown herein. The untleraignsd sprees 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 e <br /> regulations of the State Of Wisconsin. <br /> {� c o A <br /> OWNER r, /f"N .4 J m TELEPHONE 7 Q..1 q� $O f <br /> ADDRESS �� 3SI CtJy /SAY/„ moi T"�h 'P r��.7 O / m a <br /> / /- � 1 <br /> EMERGENCY/FIRE NUMBER <br /> 11,35V <br /> I�5 / ROAD NAME w /( <br /> InS r//re <br /> LEGAL DESCRIPTION (see tax receipt) St4j IS(.cJ S' r / ,r.-.3.7 R IS,L4_/CONTRACTOR �( i <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> v q <br /> SANITARY PRIVY FILLING/GRADINGCAMPING UNIT SUBDIVISION o <br /> o` < <br /> STRUCTURE/ADDITION USE: m o r <br /> ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> z a <br /> o c <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 dralntleld (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 /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 <br /> a <br /> PLOT PLAN <br /> o 'n <br /> N ' <br /> M <br /> �r <br /> 0 � <br /> 0 <br /> N I` <br /> O <br /> J <br /> O <br /> O <br /> w � <br /> z <br /> S <br /> 1 <br /> f <br /> ga. <br /> In <br /> CONDITIONS OF PERMIT: <br /> a' Q �g g,s Ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <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. [ iii S ` ' G <br /> I declare an that this application(Including any taccompanying acknowledge <br /> gschedule)thatIhas been examined by me and to the best of my knowl- �/ $$ <br /> C <br /> tides and road I It Ia true,coma 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 1 further declare that I recognize that this Infor- fnl C <br /> M <br /> malleo I am providing will be rolled upon by the County of Bumett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may W a result of the County of Bumett relying on this information I am providing in this ap- 8 g <br /> plication.I agree to Permit county officials charged with administering county ordinances or other authorized person to haus <br /> access to the above described promietis at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> (signature off owner or <br /> building contractrn(date) <br /> ZONING ADMINISTRATOR —�-1�"t i'(.1 Y1� �d <br /> SEP 2 6 19M �' ' <br /> TOWNSHIP PERMITS MAY BE RF�OUIRED t. ,L_.—.-_____ e B tX �'l(n$ m <br /> _ _ _ 888 81818m <br />