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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m 3' o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and N <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremen s of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the li iws and 3 <br /> regulations of the State of Wisconsin. m m <br /> w � <br /> ((//����' O <br /> OWNER � ;c-h&i..J L. i- MYRNN X JIA :5 TELEPHONE - c/z6 - sol? <br /> m j1 " <br /> ADDRESS <br /> ,,i.. Rirt� / i N S ( la rKcr SScA� <br /> EMERGENCY/FIRE NUMBER ROAD NAME ••� I 4e Wr <br /> rr <br /> LOT LEGAL DESCRIPTION (see tax receipt) <br /> 7 <br /> i.3 f',Sfr1 N uv ��` T I "r'W.. 37 /Y - $ <br /> / 1 <br /> CONTRACTOR n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION U� p ,•;/ <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: t4o W" J X 37 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> 9 ` e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) U <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). Irl 111 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). k) <br /> 3. Show dimensions In feet of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. C / r-• <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE IsSUED. <br /> 71 Z Q <br /> PLOT PLAN <br /> o a <br /> m H <br /> 0 <br /> C ' <br /> f4 <br /> to -, ', <br /> Z <br /> f%) <br /> 0 (} I <br /> o � <br /> _ �aj <br /> t <br /> "J Ln M rn <br /> CONDITIONS OF PERMIT: Z F 8 <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. ='4 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED ' A: m <br /> ��. : �� ' O <br /> i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowI� 1 )? !E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of I informs I 'r- s+m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inforo ) <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue ait. ; $ at <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this app' N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized Pers n to nave ut p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE5- <br /> (signature of ner or building contractor) (date) <br /> ZONING ADMINISTRATOR f� x <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N N m <br /> 0 :0 yt n1 <br /> 00 0 0 0 $yx M <br /> _ ci <br /> �' <br /> , o <br />