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M 6 I I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54472 Office of Zoning Administrator m m o 0 <br /> >E <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersi ned makes <br /> g by application for a Permit for the work des ribed and w <br /> here <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 th 3 laws and (� <br /> regulations of the Stale of Wisconsin. a m J <br /> OWNER\ `i�,1 a 1\ I TELEPHONE -3a I C I <br /> —7 a EO <br /> ADDRESS ���ryJJ��M--ill... ���[�r-V6R(XX��� 0.r r\2 514-e-n W\ STS <br /> ( 0 a <br /> EMERGENCY/FIRE NUMBER -Igt!'U �/ ROAD NAME &DLL) <br /> q L <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Pe &\5c2 \ Cc/-SAIU kG/ y ^ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O V - <br /> n � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o < <br /> 1 � <br /> r <br /> STRUCTURE/ADDITION USE: C1,SC�C 0 a <br /> (Home/Cabin;Commercial Busi ss;Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> a <br /> m <br /> 3 <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,( )building <br /> measurement to the ordinary high water mark of lake,stream,or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 0 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in o rn <br /> c <br /> PLOT PLAN o <br /> c"�\� R o to <br /> µ \ 'i"I �� C <br /> I fn v� <br /> o <br /> U � <br /> ,k\\ coV L: ,u -1 <br /> loo ` <br /> 0J3 0 <br /> l , <br /> a_ 1�1eR. <br /> aV <br /> 1<zee_ y <br /> c�cCP-I I <br /> oo <br /> m m <br /> CONDITIONS OF PERMIT: 2 : Z `$ g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. cI —I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n'-I W >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i"i, : 25 : : m <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 informs- ' •+m"' T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issus a permit. 1 <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 poison to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. e <br /> m ' <br /> SIGN HERE �3"9r7 N f0 <br /> N: <br /> (signature o1 owner or u Idin cot A (nate) <br /> ZONING ADMINISTRATOR E $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED (MO TI <br /> g� � 55� �35m <br /> `8 $ 8 $ 8 $$ ) <br />