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Burnett County 74 0 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> PPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADM ISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herei 1. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land U e Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ 2. <br /> regulations of the State of Wisconsin. �, d <br /> Sy�eN 3Yg-sa6U C <br /> OWNER v I -1/— TELEPHONE / n c/' n O <br /> '� o ,i6 <br /> ADDRESS <br /> EMERGENCY/FIRE NUM ERLl <br /> ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / t l// lo/q �1461 <br /> \ <br /> CONTRACTOR S <br /> TYPE OF PERMIT(S): D ELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PR VV FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> STRUCTURE/ADDITION USE: UZ / y kAe O r//�/,Q�ut 9,4s8owl n <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom;D ck;etc.) Z <br /> o ° <br /> 0 <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location 3nd size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location f the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a)buildingto 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 ar submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the ownerO i? <br /> NOTE: BUILDING/STRUCT JRE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a rn <br /> c <br /> PLOT PLAN n o-74 <br /> a <br /> SPP 1i=1�z 1 / loL M a c <br /> �P ? 541" `fir 1400"na ��� N O <br /> f � <br /> C!f <br /> °/a 1 N crco+e O <br /> D '�, cello o <br /> m <br /> o � <br /> ° W <br /> (v Z <br /> a <br /> O_ c aNi rDi a f m <br /> m K4i Q$ 9 <br /> CONDITIONS OF PE MIT' m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y^, _ to M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. F $ . <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- 1, , y &r? m <br /> tion contained in this pplication(including any accompanying schedule)and I further declare that I recognize that this infor- ii; or <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� <br /> further accept all liabil ty 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 pe mit county officials charged with administering county ordinances or other authorized person to have i <br /> m N p ua <br /> access to the above di isclibed pr ises at any Won!b[ imefpr the purpose of inspection. <br /> m o <br /> SIGN HERE m "" <br /> (si to of owner or b 'd ng contractor) (dal ) <br /> o [ <br /> �i <br /> ZONING ADMINISTRA R <br /> X -X <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000 8 0 rrn <br /> mA <br /> a <br />