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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m __ 0 <br /> APPLICATION FOR — LAND USE — PERMITS g. <br /> 0 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. — o <br /> w d <br /> C m <br /> OWNER L.1 ) P -rl TELEPHONE i(eq ,� 7sV n F <br /> ADDRESS (y/ i;;Z0 — Et*lwl m J m <br /> v <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> N(ya- :SF- <br /> CONTRACTOR <br /> - <br /> CONTRACTOR fj o p 11lvC/I C4A/ST (p89— Alf <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION _ p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> 0 <br /> ^ r <br /> STRUCTURE/ADDITION USE: O )( <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z a - <br /> 0 c <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. <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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, on a rn <br /> on c <br /> PLOT PLAN A o 0 <br /> m <br /> to J� <br /> . l <br /> 9 t t*t <br /> I <br /> N <br /> j\ <br /> p `v `7 (o1ua) i j5(A*.„Vytr,,. <br /> Dll'� <br /> NO C d > n >. y n] <br /> 0 — iii > > 0 � m <br /> CONDITIONS OF PERMIT: ? m < m c m o <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Fji <br /> ?r � ? a <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." : ro n to <br /> g n � <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 informa- w m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 N <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 cptunty officials charged with administering county ordinances or other authorized person to have O ut p <br /> access to the above descy6ld premises at any reasonable time for the purpose of inspection. 0 $ $ <br /> m m A N <br /> A 8y <br /> H N <br /> SIGN HERE <br /> w a <br /> (sig ur o ner orb it g contractor <br /> ZONING ADMINISTRATORV 8 <br /> j ;"� ^f^ (^ d $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,jUi_ C:� a N o a N <br /> V� 88888 rn <br />