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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N -0 + z <br /> m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m mw _ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. o <br /> N a1 <br /> OWNER / ' � v(� ��f y��J TELEPHONE 6 / ? '2 G^ o 'L� o <br /> ADDRESS!!! YOo..IC u/LLd-J �YGT <br /> ( 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 7 <br /> LEGAL DESCRIPTION (see tax receipt) 5 /�//�Yca� (s4, �� 4�J t fd t5 Com( O <br /> CONTRACTOR /( H � !E' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> SANITARY PRIVY0 FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: _100 IQ 6tqC o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) - Z <br /> 0 ° <br /> a <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DIF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 1A <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 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN o m <br /> c <br /> PLOT PLAN o a <br /> < <br /> M o <br /> /✓ M <br /> o I <br /> 4 zb_ <br /> p ° <br /> L N <br /> F o <br /> is <br /> O y <br /> N <br /> r <br /> a <br /> �ep �e <br /> I <br /> D �N-0(a r D DO -0 <br /> 0 cam.> > '0aF m <br /> m Dg� Damm &0 m <br /> CONDITIONS OF PERMIT, $ < y.: Z C 8 S r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m& <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F =N <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. t7 2 : i m <br /> o a2 O <br /> 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- rn m dr m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 vg <br /> o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing inlois ap- <br /> plication.I agree to permit county officials charged with administering county Ordinances or other authorized person to have E O N p <br /> access to the above de cribed premises at any reasonable time for the purpose of inspection. <br /> m ` v Q 0 <br /> n m A . <br /> �1 <br /> SIGN HERE .. I <br /> H <br /> (s' n tura of owner r ilding contractor) Ufl p Fr <br /> ZONING ADMINISTRATOR PS <br /> TOWNSHIP PERMITS MAY BE REQUIRE ii o N N N PO N 8 N m <br /> -- - 00000000 0 <br />