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AA <br /> Vr r �! <br /> 'ourtty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m 0 O <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> ,1E ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and v w <br /> .ated as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremen s of the m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the 11 ws and 3 (, \ <br /> _ (� o JFK <br /> regulations of the State of Wisconsin. r��__ �(�,�„_. �L� ..xii �, m <br /> o <br /> OWNER <br /> �—� "�,;��r � - TELEPHONE <br /> m <br /> ADDRESS ._ � -� T'1 �; Z <br /> c � <br /> EMERGENCY/FIRE NUMBERI ROAD NAME <br /> C <br /> LEGAL DESCRIPTION (see tax receipt) <br /> r <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION - <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING R SU IVISION o` ° <br /> o T, <br /> STRUCTURE/ADDITION USE: 41 <br /> (Home/Cabin;Commercial siness;Bedroom; Deck;etc.) I --I ' -�$- - Z o <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 (N),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet of thefollowing:(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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ed and 9 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. ON o m <br /> 71 Z `a <br /> PLOT PLAN P n <br /> 1 h O C I <br /> m <br /> 0 <br /> m <br /> N <br /> \ \ <br /> go4C ITO L�O-CJZ - �D � <br /> -r20% oT �o��a <br /> f <br /> m <br /> m Dg� �-�'awm_ >7 <br /> CONDITIONS OF PERMIT: < m' `z CS g E C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p Zh'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" gin, m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- t <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- i «m« In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I $`� $ <br /> further accept all liability which maybe a result of the County of Burnett relying on this information I am providin In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized part on to have <br /> access t0 the above described premises at any reasonable time for the purpose of inspection. <br /> Ir r <br /> SIGN HERE <br /> (signature of owner or building contractor) I. (date) E �' <br /> ZONING ADMINISTRATOR 3 ': ' 8i <br /> �I <br /> TOWNSHIP PERMITS MAY BE RE011111111114i ��_ ___-�_ , o i) a b N N m <br /> $$ $ 8$ 888w <br />