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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. — <br /> d o <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and 2 H <br /> located as shown herein. The u dersigned agrees that all work shall be done in accordance with the requirements of the -,-24 m <br /> Burnett County Land Use Ordini ince,Sanitation Code, and with all other applicable County Ordinances and the laws and �3 a <br /> regulations of the State of Wiscc nsin. H m <br /> w � <br /> _ c <br /> OWNER JoNN p_ � j TELEPHONE �a <br /> �/// J m m <br /> ADDRESS <br /> a3/7 tiTi �!IZC�C v gP��li�«-1�� 6a 5�� m <br /> EMERGENCY/FIRE NUMBER 0 Tz5 7 ROAD NAME 31'0T-xAV-) ?' ('/p <br /> �p <br /> LEGAL DESCRIPTION (see tax ret ipt) �L \ 7 <br /> CONTRACTOR N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING lic — GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n O J <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 1 p o <br /> _ w � <br /> STRUCTURE/ADDITION USE: C$ /a6� O o <br /> r <br /> (Home/ ab Commercial Business;Bedroom; Deck;etc.) -Z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) `rl <br /> 1. Show the location and slzc 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 he following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinay 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 <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 rn <br /> c <br /> Z Q <br /> PLOT PLAN n <br /> m o <br /> C I <br /> M <br /> w <br /> C� <br /> 0 <br /> f pc�t <br /> e a� 2Xcw�a�tec� <br /> I,e J <br /> LN�2 wfU cry). 57.4 s A 7J� t �wf N°� lr'✓Lf ' <br /> SrsP fw <br /> Sore r /aC"4aj Z�0-r 7X4,6 , y or GrQ,�-IL / <br /> rtDi > <br /> m <br /> CONDITIONS OF PERMIT: < : --2 CS . a <br /> 1. DRIVEWAY MUST MEET (DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z £o' 'z 1 <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o N I 31 <br /> 3, NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ti6 2 j!� m <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- oB I C <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 m <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> malion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 1 $� <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- y, <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have w N m <br /> access to the above described premises at any.reasonable time for the purpose of inspection. m <br /> c a <br /> `2 Pm <br /> SIGN <br /> SIGN HERE (sazue fototractor) (date) <br /> ZONING ADMINISTRATOR E; <br /> Sw <br /> .w.' <br /> ^- <br /> \, <br /> o <br /> x E <br /> X :X;x <br /> TOWNSHIP PERMITS MAY BE REOUI o m <br /> gy <br />