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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 11 M -+ z <br /> � m f <br /> APPLICATION FOR — LAND USE — PERMITS 3_ o <br /> TO THE 20NING ADMINISTRATOR:The undersigned hereby makes application for a Perms for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 2� (-)� <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. N <br /> [/ c <br /> OWNERDave �Cll- -�V(Q r1 TELEPHON�f_(�(�) "7� _ S� i 7 a ^ o <br /> o <br /> ADDRESS <br /> m <br /> I k+ I BvX P MOV-4- LM PA 'SSos-1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) ". I' -r- q� �, I� UL/ <br /> CONTRACTOR Ul1 (f <br /> TYPE OF PERMIT(S): DWELLING/BUILDING i TS'7GARAGE/ACCESSORY STRUCTURE ADDITION p • <br /> n <br /> SANITARY__ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVI ON o <br /> o ;- <br /> STRUCTURE/ADDITION USE—V.) <br /> : )et'Gry h yj'jV 1 I /- -fll i T o ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) ZO <br /> 0 0 <br /> a <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 'F <br /> Q " <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). ,,'X� 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 <br /> measurement to the ordinary high water mark of lake,stream, or river. C <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. on v rn <br /> Milt <br /> c <br /> PLOT PLAN o n /� <br /> a <br /> M ¢; <br /> vJ-) <br /> m <br /> o <br /> N <br /> Q <br /> Z <br /> I � <br /> C 1 <br /> >a� 9 <br /> m Dg� a0c 21=31 <br /> CONDITIONS OF PERMIT: a � C8 0 roLi <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F '0 : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i _to M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i6 2 i i m <br /> o : ip C1 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- U o i R- <br /> Ri C <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 a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 'b' o ; <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- w <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. w c m <br /> 90 <br /> m m <br /> SIGN HERE ` <br /> (signature of owner or uilding contract r) (date) <br /> ZONING ADMINISTRATOR <br /> wtn..ds Fnwr�a 'n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000000N <br />