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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 03. <br /> a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 a <br /> regulations of the State of Wisconsin. <br /> w � <br /> c <br /> a O <br /> OWNER 1"13 C--, �tSS� TELEPHONE o <br /> ,1 n T m <br /> ADDRESS .2310 S. LALyKi> AAclII is&A mx /�o0i OI m <br /> 7- <br /> EMERGENCY/FIRE NUMBER ROAD NAME C+ c <br /> TVA L ' <br /> LEGAL DESCRIPTION (see tax receipt) Ct►+'� J 5 t�g a�nJ'k L+ _Su) LSE. 5 .24 Too RA � <br /> CONTRACTOR ��" O � (^ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING _ GARAGE/ACCESSORY STRUCTURE_ ADDITION V p 0 <br /> SANITARY_1// PRIVY FILLING/GRADING - CAMPIW UNIT SUBDIVISI 0� <br /> I JJ r <br /> STRUCTURE/ADDITION USE: ,e S 0 LA <br /> (Home/Cabin;C mmercial Business; Bed om; Deck; etc.) Z v <br /> 0 0 <br /> v <br /> m <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. Q <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 ONSrFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a <br /> PLOT PLAN 0 <br /> o � n <br /> — J I. \ <br /> M <br /> N <br /> N <br /> w <br /> A_ <br /> 0 <br /> �O1 <br /> 0 <br /> L a�J <br /> o IIµ- <br /> 0 <br /> O � <br /> H <br /> E <br /> Z <br /> DDOy <br /> > > oaFm <br /> —g� allom <br /> CONDITIONS OF PERMIT: $y.: Z C 8 0. m ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. oZ F 0, i �'2 i 1 <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. o a n : D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know(- <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 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o ; m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o'R o <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 0M 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 0 3r' <br /> D : 3 A w <br /> SIGN HERE «+w 0I <br /> (signature of owner or bui in trpct Vj <br /> ZONING ADMINISTRATOR ? `- <br /> ^,r� -n <br /> TOWNS1, PERMITS MAY BE REQUIRED o o" 8 m <br /> ( 0 <br /> m <br /> 0 000 f1) <br />