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Burnett County 1410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratora o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and T m <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 _ <br /> regulations of the State of Wisconsin. m <br /> 10 <br /> OWNER �h�ri K. f�Dsefl�ine TELEPHONE <br /> ��j <br /> �{? <br /> ADDRESS �O $4mk S4. # 1 04 Allln[pDDIh MW J55LII7J m 1 <br /> EMERGENCY/FIRE NUMBER r ROAD NAMW <br /> G <br /> a 11 / <br /> LEGAL DESCRIPTION (see tax receipt) See All ,erl7 P O/ <br /> Vf' <br /> CONTRACTOR Various <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION o �� <br /> Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo` 0 <br /> ° <br /> CQdin N <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z a <br /> 0 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 (DF). 3 <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. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a y <br /> 71 Z `a <br /> PLOT PLAN ° S.a <br /> N <br /> O <br /> I <br /> C) r <br /> f� <br /> r N <br /> See <br /> m � <br /> o <br /> N_ <br /> n <br /> 1 <br /> Se14e ve,- <br /> 9 <br /> g�` T ��ak� —� oHc�M• <br /> mS N W T.0 r D D WD <br /> CONDITIONS OF PERMIT:' g• i Q a o 30 r+ <br /> f. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zo 5- : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. oi T N <br /> = a : i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q <br /> g C <br /> I declare that this application(including an accompanyingschedule)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- <br /> In <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 $a $ <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• r u <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ON , <br /> access to the above described prem sea at any reason le time for the purpose of inspection. : O - <br /> r ` 3 $x€ <br /> A m <br /> SIGN HERE <br /> (sign ur of owner or tipliding contractor) (date) $ <br /> ZONING ADMINISTRATOR <br /> i3�.'iwfue="= " <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N O O , rrnm <br /> 888888 $ 8m <br /> CLW �5-oiTF <br />