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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ' c c <br /> APPLICATION FOR — LAND USE — PERMITS m 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations Jo1fthe �of W' o sin. 'f Y�1 <br /> I/ y�er� iia <br /> OWNk4rSOn <br /> ' . —r^'wr C tCarez4 <br /> TELEPHONE �) _ q Q a £ <br /> ^� ll � ^ y'� �J� III{-� In "f /ti�� m_ <br /> ADDRESS 4 / o� I �5karo/ , ` r {��1111�"7c A/� MAI <br /> 1_ <br /> EMERGENCY/FIRE NUMBER 357 4-7 ROAD NAME <br /> Y' <br /> LEGAL DESCRIPTION (see tax receipt) 1 f 3 �1 "` , <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION �\ p <br /> SANITARY PRIVY0 <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> ° <br /> STRUCTURE/ADDITION USE: ���� �Us.. I �[. I �(J ( o Tj <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> v <br /> ° <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 dralnfield (DIF). I i <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building -q <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 w <br /> PLOT PLAN Z ° <br /> o n <br /> m o <br /> CX J <br /> M0 <br /> lad+ �. <br /> Re V4. <br /> � N <br /> ' <br /> N <br /> o <br /> C <br /> Z <br /> / z <br /> NO I njs(fie P I k�'-6n� �A <br /> / U U _VU r ➢ D <br /> m D )i v5 y a m a m <br /> CONDITIONS OF PERMIT: 00 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? 21 , 1Q ? 0 3 <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. Gr 0 <br /> C E a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa .61 <br /> m M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor V N V 8 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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 O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> M O A <br /> SIGN HERE <br /> 'gn re o owner or i ng contractor) (date) x, <br /> o : <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIREDCH N N + N N H (�, n <br /> N U N O U O o 0 m <br /> �88888888w <br />