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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ca <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 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin, rod <br /> m m <br /> OWNERTELEPHONE <br /> 00001d 0—nA, 4 <br /> I <br /> ADDRESS 0/ /O t1bou 1 _ ip S�I'CN I`d LS <br /> EMERGENCY/FIRE NUMBER 9yV16) ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Jam_ lPA/ 5e& )° T� <br /> /✓gN Rhu ^ <br /> CONTRACTOR y�S <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> STRUCTURE/ADDITION USE: .�lDvil/iT/o--t o 4 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> c <br /> ° <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 (W),septic tank (ST), and drainfield (DF). <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. Q <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. 0 0 <br /> NOTE: BUILDWG/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, a <br /> c <br /> PLOT PLAN o a /� <br /> M N `Iryl <br /> 7 <br /> 766 *4- -16 Al'�A m <br /> bm� ?SIla <br /> i O <br /> J <br /> C ' <br /> o <br /> I <br /> Imo' <br /> Z <br /> i <br /> o in =. m m a a : m <br /> CONDITIONS OF PERMIT: o So <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m I C <br /> g : n c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. n, om `� I m <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- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i O u, o <br /> access to the ab des ibed pre ise at any reasonable lime for the purpose of inspection. 3 8 x <br /> M i 9 A a <br /> A A A <br /> SIGN HE 511q H a g <br /> N <br /> 17- (s' a re of owne r Ilding contractor) (date) . <br /> o : <br /> ZONING ADMINISTRATOR �' <br /> ell <br /> Of a <br /> TOWNSHIP PERMITS MAY BE REOUIRED »N N N m <br /> X88888 8a, <br />