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Al Cen'Ylf'.� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m .,o -1 z <br /> APPLICATION FOR - LAND USE - PERMITS <br /> 3 <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit 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 m <br /> Burnett County Land Use Ordi aria,Sanitation Code, and with all other applicable County Ordinances and the laws and 3. <br /> regulations of the State of Wisc nsin. - o 1 <br /> OWNER ;\ / / n = n O <br /> -y-- - TELEPHONEI- _ � /� � �-, -� � � <br /> ADDRESS/-/? _} m ,o <br /> lfC/tJ U1"l 52 JF0-2 <br /> EMERGENCY/FIRE NUMBER <br /> r v I ROAD NAME <br /> LEGAL DESCRIPTION (see taz re eipt) �' <br /> CONTRACTOR —777, -� <br /> TYPE OF PERMIT(S): DWELLING BUILDING �GARAGEACCESSORY STRUCTURE ADDFFION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o / <br /> J <br /> STRUCTURE/ADDITION USE: _ 6 i " l <br /> o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLAI 4 DRAWING: (Aerial or top view) <br /> 1. Show the location and siz of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the w ll (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of he following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordina y high water mark of lake, stream, or river. <br /> 4. If separate plans are submi ted by an architect,engineer,builder,contractor,etc.,the plans must be signed and p , <br /> dated by the owner. 0 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 0 <br /> PLOT PLAN z ` <br /> /! <br /> m <br /> { A-)) C <br /> 9 M <br /> 0 <br /> .N r y <br /> Q <br /> V r I m <br /> N <br /> r'. 5 <br /> 0. <br /> Q <br /> l� z <br /> I � � <br /> rn <br /> 1 ' <br /> CONDITIONS OF PERMIT: I -- ' /' v m c <br /> 1. DRIVEWAY MUST MEET D VtWAY WIDTH REQUIREMENTS yN'FHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o: i t.z : <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS STRICTED ALONG SHORELINE. ° E n : : �3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ,vii 62 : m <br /> 0 <br /> I declare that this application(inc luding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct ind complete.i acknowledge that I am responsible for the detail and accuracy of all informa- u w T : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a <br /> mation I am providing will be re ied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o'$ <br /> further accept all liability which r iay be a result of the County of Burnett relying on this information I am providing in this ap. <br /> plication.I agree to permit count officials charged with administering county ordinances or other authorized person to have i N i <br /> access to the above described p emises at any reasonable time for the purpose of inspection. CD mom <br /> m " <br /> SIGN HERE <br /> (sig ature of owner r building contractor) (date) <br /> op ?f i <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP PERMIHHM+NMrp(y S MAY BE REQUIRED T o N N N N m <br /> 0 0 0 00 o p m <br /> 0 0 0 o S o 0 0 (A <br />