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Burnett County 7410 Co. d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator V�t 7 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3, <br /> TO THE ZONINCADMINISTRA R:The undersigned hereby makes application for a Permit for the work described and H <br /> ° J <br /> located a8 shown herein. The ut idersigned agrees that all work shall be done in accordance with the requirements of the m A m <br /> Burnett County Land Use Ordina nce, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisco isin. w m rvl�1 <br /> m <br /> OWNER 1 'e t 6Y,, TELEPHONE' <br /> O ' <br /> j ,J1 m i tD <br /> ADDRESS 6 f O-ir `.l 0J 11 <br /> EMERGENCY/FIRE NUMBER ROAD NAME I S W —� <br /> LEGAL DESCRIPTION (see tax rec 'pt) OQ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/ UILDING_V GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY___ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: I -dr 0,1k 1 loo S-e o ° <br /> Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <br /> I�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 thew II (W),septic tank (ST),and drainfield 1 1 r <br /> 0 <br /> 3. Show dimensions in feet of tI ie fol lowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarf 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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '" o N <br /> PLOT PLAN z `v <br /> M o a <br /> r ARS.e � In <br /> C <br /> N <br /> Z <br /> o <br /> 1 0 <br /> o <br /> 5x7 {-'rDQfor ,mss <" <br /> �a$ iFce-f I r" <br /> +OW,p/�ry Yro <br /> - <br /> I 11 per,} ko Sc <br /> � z <br /> rx <br /> u <br /> 2. a <br /> 0fnr9 lb oO.m <br /> F m <br /> m <br /> 0 <br /> CONDITIONS OF PERMITS S c, N : Z o ' $ <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 T� <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^� <br /> 62 <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'm ^ C <br /> $ ` c : <br /> I declare that this application fir cluding any accompanying schedule)has been examined by me and to the best of my knowl- o I m m <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this applicatio i(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be r flied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ m $ <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 p, p Q. <br /> access to the above described remises at any reasonable time for the purpose of inspection. 03 $ U <br /> In W ^ N <br /> 12 m aaS�• <br /> SIGN HERE <br /> (si nur of owner plr uilding contractor) <br /> d <br /> ZONING ADMINISTRATOR KV 1 119% g <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />