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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <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 m c <br /> Burnett County land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and /a <br /> regulations of the State of Wisconsin. <br /> c g <br /> OWNER �£� 1-t1iZS�N TELEPHONE `I"L - L4.5,7 . <br /> i7�t^f m <br /> ADDRESS 4348 �kAMi�Tnnl �R. t~aaN, mg. SS a3 'J4. <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 'f eea5 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION p K <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTUREADDITION USE: 6�n� nq '4- acde o` <br /> o r <br /> (Home/Cabin;C mmercial Business; Bedroom; Deck tc.) U Z <br /> 0 0 <br /> a <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 (V ),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)bullding 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,englneer,builder,contractor,etc.,the plans must be signed and C�1, <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o rn <br /> PLOT PLAN o n <br /> 0 O <br /> M z <br /> 0 <br /> 0 i <br /> O L <br /> J <br /> m <br /> N <br /> r <br /> cC <br /> Z <br /> N <br /> 31 c-d O, r>>0 -0 <br /> CONDITIONS OF PERMIT: c y. ,z as 3 5' � <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - _=N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - �' O2 : m <br /> Or <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- N m N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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. nn <br /> m 3 w <br /> _ <br /> SIGN HERE U <br /> ZONING ADMINISTRATOR I I $ <br /> NM NMN+N T <br /> MITS MAY BE REOUIR �.11` N N g <br /> TOWNSHIP J N m <br /> 888888 UM) <br />