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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <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 c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ o- <br /> regulations of the State of Wisconsin. <br /> O <br /> OWNER TELEPHONE WiPrso� <br /> ADDRESS 313c, Me- rein kPj St jl1f,E J41 o%S r W <br /> EMERGENCY/FIRE NUMBER 65273 ROAD NAME ba V/Ja.-x A t1e— , <br /> t T, <br /> LEGAL DESCRIPTION (see tax receipt) S to j S Lw <br /> CONTRACTOR I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 G7 <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o TC' <br /> J (� <br /> w r <br /> STRUCTURE/ADDITION USE: o °— <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 <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 dralnfield (DF). P6- <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 9 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 Ip.� <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M Q <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a rn <br /> PLOT PLAN Za <br /> o a <br /> M .. N <br /> � 0 <br /> S o` <br /> N <br /> O <br /> m <br /> 2 \ ti <br /> n Vv <br /> Z <br /> X <br /> of <br /> 33 <br /> 0. $.fm <br /> D w <br /> CONDITIONS OF PERMIT: v Z c$ 2 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <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. <br /> 62 m <br /> ig <br /> I 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 '^a a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- is o : G <br /> mation I 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 m N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. R <br /> m 9 ^ 0 <br /> tD m <br /> M w O <br /> SIGN HERE .n $ <br /> (signature of own or b Idi tractor) (dat It? UJ <br /> ZONING ADMINISTRATOR <br /> N M H H H"e9 n <br /> TO Sm <br /> HIP PERMITS MAY BE REQUIRED o ul u, N 0 N m <br />