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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. y m <br /> c <br /> I/A L n O <br /> OWNER 91:4 (. 1'dj� � TELEPHONE g�.t� �' � r '2o <br /> ADDRESS S_S O 9 A�I 2 rt U m <br /> EMERGENCY/FIRE NUMBER ROAD NAME / r J <br /> LEGAL DESCRIPTION (see tax receipt) {- O�m VOI O F !lI C 739--e <br /> 0- \ <br /> CONTRACTOR �OCEN _ /_ o G L <br /> of <br /> TYPE OF PERMIT(S): DWELLING/BUILDING _ GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> i <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <. <br /> Ll Pte, <br /> '^ r <br /> STRUCTURE/ADDITION USE: Wf. (.hS� � o � <br /> (Home/Cabin;ComnUrcial Business; Bedroom; Deck; etc.) Z o <br /> o 0 <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (OF). 0 <br /> 3. Show dimensions in feet ofthefollowing:(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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> PLOT PLAN Z v <br /> n P n <br /> n p C9AlSl���1 fA 0 <br /> pn� fp 21-4? <br /> n_ <br /> 0 <br /> N <br /> w <br /> O _ <br /> l <br /> hr f,p / <br /> OF <br /> "7I9 Its <br /> ♦1/ /O itUD <br /> CO T�L4-W m <br /> m -g,� 2am p'$ y <br /> CONDITIONS OF PERMIT: d �� ^ m y' Z C8 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - St�b : m <br /> o : E : <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: i C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- »m a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 9 ig o : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0'$ <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 offici Is charged with administering county ordinances or other authorized person to h 0" p <br /> access to the above des ribed premi sat reasonable time for the purpose of inspection. m 3 bo <br /> m m A N <br /> SIGN HERE <br /> D o <br /> -.l »: `�' <br /> (si a of ow r r ing contractor) (date) <br /> ZONING ADMINISTRATOR T- <br /> �. . <br /> dl Yl dl�bfHdpl iH�-t <br /> TOWNSHIP PERMITS MAY BE REQUIRE o N N O N o N Im <br /> - 000006 N <br />