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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm m o / o <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> m s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work d11awg <br /> ibed and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the reqthe m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances aand 3 <br /> regulations of the State of Wisconsin. w m <br /> O <br /> OWNER (J � -� 7 TELEPHONEr ! L r✓Pr __ mADDRESS / m <br /> S�Q v^ �mrcle // /� yEMERGENCY/FIRE NUMBER ROAD NAME �, t°r't5 /C LEGAL DESCRIPTION (see tax receipt) L.fit41e)rt <br /> f <br /> C1 O <br /> CONTRACTOR SELF fs <br /> fD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O -- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> //,, <br /> STRUCTURE/ADDITION USE: /7`O i17 rF t lcken j B.iC�e✓I S f 6.CJ S o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> = K <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 drainfieid (DF). o <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 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a to <br /> 11 Z Q <br /> PLOT PLAN ° <br /> L � f Cs,vno H <br /> 0 <br /> C ( <br /> � In <br /> N I <br /> ;0 <br /> o <br /> ° . <br /> a4x z /r` <br /> ® 6�l = � <br /> �p t pox n , n <br /> I �ti I <br /> 10 <br /> x 0.Of <br /> sa v <br /> A. aa� am r: ° y <br /> CONDITIONS OF PERMIT: g w C: 5 m 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. o E T`Z -� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> gE nSf C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m o <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- -a: yy!!m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8$ g <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 /> access to the above scribed premises at any reasonable time for the purpose of inspection. m • m <br /> �I 3 8 <br /> m v s <br /> A , <br /> N <br /> SIGN MERE �(d ' 8 <br /> (signatun of wrier orb Ing cont cl d- (date) <br /> ZONING ADMINISTRATOR <br /> 992l3 iG Z1. m <br /> TOWNSHIP PER ITS MAY BE REQUIRED LI N v vn v o o , m <br /> $ 8888888rn <br />