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e� c��-E <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 _ -- <br /> m 0 <br /> TO THS 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 3 a �` <br /> regulations of the State of Wisconsin. o <br /> N � <br /> OWNER o O <br /> / T/E�LEPHO]NE 1 <br /> ADDRESS ��r / �� ✓SG'Nu. �14 �If"/�.rn.T.Jt?UiYC� <br /> EMERGENCY/FIRE NUMBER , // <br /> Ja; t 0 OAD NAME �.S <br /> l A� <br /> LEGAL DESCRIPTION (see tax receipt) NF' / � ZY 541 �37 � 'g <br /> CONTRACTOR `f All <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY <br /> �(FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/AD (TION USE: ' -JJVQ � s, q- ��/�/ o <br /> 8/ ^ / (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) v <br /> of Z o <br /> 0 0 <br /> m <br /> a <br /> DIRECTION OR 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). o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building q <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 9 <br /> dated by the owner. O O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 <br /> PLOT PLAN z o <br /> M <br /> C <br /> m 11\ <br /> ICYc7 <br /> s <br /> d : 11 <br /> i N <br /> 0 <br /> � y <br /> N_ <br /> (1 <br /> Z \1 <br /> • � I <br /> G <br /> c M r o a 0 <br /> m -�� ' m <br /> 3m nm <br /> CONDITIONS OF PERMIT: c m- 2 c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. z m' o: : .z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F ' ' '-�to y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 62 ' m <br /> 0 : C <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.1 acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- B 8 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ? o`$ O <br /> 0 0 : <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 N <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m <br /> 3 <br /> m O <br /> 41 0 <br /> SIGN HERE 3 <br /> (signature of owner or building contractor) (date) ` Pi <br /> .g <br /> [ : <br /> ZONING ADMINISTRATOR I'� Fnlcrd.� i ` g i t <br /> a <br /> TOWNSHIP PERMITS MAY BE REOUIREDO U N N N 8 UAV m <br /> 000 og 000fN <br />