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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m --0 <br /> APPLICATION FOR - LAND USE - PERMITS 3' <br /> a J <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisco sin. p.c Ciao- 3 3 ? '? w Q <br /> O m <br /> n O <br /> OWNER TELEPHONE E <br /> ono d, nsvr✓ BGG - t"9J3 a ; \ <br /> ADDRESS F".5--op- <br /> 1-3 <br /> . op' <br /> . � 5 <br /> I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> c <br /> LEGAL DESCRIPTION (see tax race pt) <br /> CONTRACTOR Yse ��l <br /> TYPE OF PERMIT(S). DWELLING/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION__ o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING_ CAMPING UNIT SUBDIVISION o <° <br /> V r t N r <br /> STRUCTURE/ADDITION USE: ° g <br /> v <br /> Home/Cabin;Commercial Business; Bedroom; Deck;etc.) o p <br /> v <br /> m <br /> `c <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 /> r <br /> 2. Show the location of thew II (W), septic tank (ST), and drainflaid (DF). 4 <br /> 3. Show dimensions infeet oft the following:(a)buildingto all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarlir 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 <br /> dated by the owner. o <br /> NOTE' .BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a tnp <br /> 71 Z o' <br /> PLOT PLAN �0-0—f " <br /> 2 <br /> L <br /> Se m m <br /> X <br /> N 1 <br /> m <br /> SOV <br /> �o�J- r s <br /> mc��i p�r+ o of6 6.Q m <br /> a5 M <br /> CONDITIONS OF PERMIT: 1 / <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITH AiI 60 DAYS OF PERMIT ISSUANCE. o �Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^ <br /> N X2 :0: m <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 2 <br /> C <br /> 1 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 <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- a ,r` p <br /> mation I am providing will be Palled upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $r� <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- d, , <br /> plication.I agree to permit cou ty officials charged with administering county ordinances or other authorized person to have <br /> access to the abov ascribed premises,"y reasonable time for the purpose of inspection. 3 g m <br /> m ` v <br /> abui ) � �z3- gam N <br /> SIGN HERE *urewner <br /> N <br /> »: V <br /> (s' ocontractor) (date) op 3C - <br /> SX : <br /> ZONING ADMINISTRATOR � � 'r <br /> H»»9:0 <br /> » (Rq m <br /> TOWNSHIP PERMITS MAY BE REQUIRED t0 0 oo0 9:: :: : m <br /> 68 'do �Mau) <br /> yr <br /> 0 <br />