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Bumett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator o m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS _ >< <br /> m 7 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and ry <br /> regulations of the State of Wisconsin. <br /> OWNER /fesQ Kt 2 TELEPHONE E <br /> !!! 0 0 <br /> m_ m <br /> ADDRESS <br /> i <br /> EMERGENCY/FIRE NUMBER ��a 3 ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) esti / 1(.O 'Pre <br /> '- iY /G+0'y r /� <br /> 6 QO .iecvr ' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <_ <br /> r <br /> STRUCTURE/ADDITION USE: Le I—e, o 4 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z v <br /> oVJ <br /> 0 0 <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 Norl It (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). 5 <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. f- <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be at ned and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE ST KED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 0 a y <br /> PLOT PLAN L Z <br /> o c <br /> " r <br /> R <br /> yr <br /> S. <br /> o <br /> of <br /> ( N <br /> p y <br /> rr <br /> 4 Z <br /> D <br /> 1 <br /> L) <br /> f <br /> napo 0 <br /> nm 4m m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF MIT IS E. o £ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =rn; t M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^E ' O '• m <br /> 1 declare that this application(including an accompanyingschedule has been examined b me and to the best of 0 <br /> PP ( g Y 1 Y Y knows- o <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of 33 I informs- .+a u <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- In <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue it permit. 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. S <br /> m <br /> m [ a <br /> SIGN HERE <br /> (signature of owner or building cont t (dots) - a+ <br /> i i E <br /> ZONING ADMINISTRATOR i $i <br /> • NN�NN � In <br /> TOWNSHI MITS MAY BE REQUIRED N 8 N Sim <br /> $ $ 888 $ ) <br />