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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm m o 0 <br /> E <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � m <br /> Cc <br /> as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m <br /> w � <br /> A_ O <br /> OWNER aN�'TL- N6- _ TELEPHONE <br /> ADDRESS 3(? ¢ OE 6J694101t- 2j <br /> EMERGENCY/FIRE NUMBER l�7-( ROAD NAME 1, <br /> LEGAL DESCRIPTION (see tax receipt) 9 J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o �_ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDNISION o 0 <br /> m r <br /> STRUCTURE/ADDITION USE: � o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> o c <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). g <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. <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o m <br /> �I 2 a <br /> PLOT PLAN O o o <br /> m o a <br /> I J <br /> (Aw � = <br /> to <br /> f <br /> A <br /> O <br /> ISb <br /> 0 <br /> `{33 Lr ,7 <br /> 9t� <br /> W Al <br /> � ✓1 5�`a��b D� � � I� <br /> STep✓ <br /> � <br /> 6� MA. 31,5 <br /> �iy3Do� �mm � a <br /> m = a� 2-nmagM <br /> D p <br /> CONDITIONS OF PERMIT: m- Z go" om m 3: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c £ T`Z 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. - I"n L) m0 <br /> u C <br /> g aS <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 : m o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. — Gt m <br /> tion contained in this application(including any accompanyingschedule)and I further declare that I recognize that this infor- k' <br /> PP 9 11 <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 u g <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 w <br /> access to the above described premises at any reasonable time for the purpose of Inspection. . S <br /> f ' ' ` 3 8 x <br /> F-1 R A <br /> s " 8 : <br /> SIGN HERE _ - 8}� <br /> Igoe re of o r w it Ing contract <br /> ZONING ADMINISTRATOR <br /> u'Zu" ' <br /> TOWNSti1P PERMITS MAY BE REQUIRED m <br /> v ,u w o o , m <br /> 888888rn <br />