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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator mm o 0 <br /> 5 f <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v 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 _ r <br /> regulations of the State of Wisconsin. m v 1 <br /> a m <br /> c <br /> OWNER Vo., TELEPHONE <br /> m_ <br /> ADDRESS -i/00 S-A "PLre /49P/`,e Al") 4' S 9 SSS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> —1 <br /> LEGAL DESCRIPTION (see tax receipt) a�',S'�S .�pr��i 4,e,5-,71-1 e.3 k-e <br /> CONTRACTOR Se- <br /> TYPE OF PERMR(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONS p Cf) <br /> ° o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> ° <br /> STRUCTURE/ADDITION USE: G! A" o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> o ° <br /> v <br /> m <br /> a <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 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 9 <br /> dated by the owner. 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 5 m <br /> c <br /> PLOT PLAN ? n <br /> low ga <br /> I <br /> MU <br /> f <br /> IN <br /> w <br /> � rm <br /> Z <br /> m o Co m n n F m <br /> m = pmM <br /> CONDITIONS OF PERMIT: z i Z o o on 0o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o : o Z : :1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° £ ' : ` '-I r2 M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I"n [ L) m <br /> m c i i C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- m o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ,°c i y!m m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor. . g A : o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 i s u <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 described premises at any reasonable time for the purpose of inspection. 3 8 <br /> ID v A o <br /> SIGN HERE « : 8 <br /> (sign f owne r ilding contractor) ( <br /> date � p : <br /> ZONING ADMINISTRATOR -"'`� i% G���"«^ FO P U `-' NN <br /> : x <br /> TOWNSHIP PERMITS MAY BE REQUIRED 131N N ro o ti m <br /> NOV 161992 sssssssr� <br />