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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn9 v -1 o Z <br /> f <br /> APPLICATION FOR - LAND USE - PERMITS I _ <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 m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable Courtly Ordinances and the laws and <br /> regulations of the Stale of Wisconsin. o <br /> OWNER /S�IIh _T <br /> TELEPHONE�- fl`)CC�Uz(:-lti Lees TELEPHONE CO w� �1�� : �O <br /> ADDRESS -» o <br /> /h�rJ l,�h,�,akeQ �//direr Rr, m.f,' zz-,00 <br /> EMERGENCY/FIRE NUMBER ��j��/ ROAD NAME L j J- �( <br /> LEGAL DESCRIPTION (see tax receipt) L0T (o 4LtV't Tion=��f'��5 DIFF-rC._S <br /> CONTRACTOR ` J1 <br /> TYPE OF PERMIT(S): DWELLING/BUILAgWill GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> STRUCTURE/ADDITION USE: Lode /7m o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> m <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 North (N). T <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 5 - <br /> 3. Show dimensions In feet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c I building �J <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 I ned and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFrE VERIFICATION BEFORE A PERMIT CAN BE SSUED, 3 <br /> ---------------------------------------------- <br /> y <br /> PLOT PLAN _� Z ` <br /> .0 0 ' <br /> �� � <br /> kA <br /> Irl <br /> 0000 <br /> �u <br /> Z <br /> L ` <br /> S i�c�iomDnOmi <br /> 0 m <br /> CONDITIONS OF PERMIT: 1 v $R. C g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z f =m'o': ffi.2 <br /> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n--m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 <br /> aa� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 : m ' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- B IT <br /> motion 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have o <br /> access to the above described promises at any reasonable time for the purpose of inspection. g <br /> SIGN HERE <br /> N: <br /> (sig u of owner r wilding contractor) <br /> /// <br /> ZONING ADMINISTRATOR � <br /> TOWNSHIP PERMITS MAY BE REOUIRED ,.I I n w N N !~1n N~N'N«1T T <br /> O f n e N O m N N 0 m <br /> i U All__----- 99999999 UP <br />