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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 ' c o <br /> APPLICATION FOR — LAND USE — PERMITS _ f <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 the laws and n <br /> regulations of the State of Wisconsin. <br /> / / c t° 7 <br /> OWNER J TELEPHONE n f <br /> ADDRESS S/ J I y�r/ f <br /> CD <br /> �•) tl/C U /R��/µ4��J /i/il ))Q�Z � <br /> 1 <br /> EMERGENCY/FIRE NUMBER fd ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / ✓ `` f L/ I \i <br /> CONTRACTOR <br /> J \ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p ]� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c o J <br /> l � 6-1, r D <br /> STRUCTURE/ADDITION USE: <br /> l�qt j R��i, , G� c r) Q }(� o o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o ii /\ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) i V <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). o <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 X DD <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c N <br /> PLOT PLANc n <br /> KL fn y <br /> 0 <br /> 75 w -' <br /> K <br /> r <br /> 20 <br /> h C: <br /> o <br /> �ei- �OU�t TO C^'1 <br /> 1 / N <br /> 0 1 <br /> 3 <br /> m <br /> 3 G o <br /> IU �� <br /> P�4,In <br /> o c m m n a <br /> = " no m <br /> Dai • m <br /> CONDITIONS OF PER Li <br /> v z.: o.a c <br /> On 4=0 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c m c it-2 , , -•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. 32 <br /> i ' D <br /> PP (including Yaccompanying ) y 8 ` a� C <br /> I declare that this application mcludin an schedule has been examined b me and to the best of my knowl• 8 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa• <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ' 'm m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g o g 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 �^ <br /> access to the above described premises at any reasonable time for the purpose of inspection. I ro o <br /> -n : E 3 <br /> M Aro . <br /> (D <br /> SIGN HERE 1744t 8 <br /> sig u of owne r uilding contractor) (date) <br /> ZONING ADMINISTRATOR ti { `• x <br /> E 8 i <br /> TOWNSHIP PER ITS MAY BE REQUIRED m <br /> 488888888 v) <br />