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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d - c o <br /> 3. E <br /> APPLICATION FOR - LAND USE - PERMITS m � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <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 Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w m <br /> �^ m <br /> OWNER ,-� � f� - TELEPHONE a F <br /> et <br /> ADDRESS t/ O C;- <br /> EMERGENCY/FIRE <br /> EMERGENCY/FIRE NUMBER //b ROAD NAME AU. <br /> LEGAL DESCRIPTION (see tax rece�i7pt) L e � C-541- V 6� •7 r�� pL� fc<�7 -t-fo l f�(yW n <br /> CONTRACTOR / '. .. ,. _- <br /> TYPE OF PERMIT(S):GDWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> a O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o` <. <br /> /� ° <br /> STRUCTURElADDITION USE: Z-4UL,-t:) Af-&x L OO/✓) o °• <br /> (Home! in;Commercia usiness;Bedroom;Deck;etc.) Z T <br /> o ° <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o y <br /> C <br /> PLOT PLAN o n <br /> m �= <br /> C !`0 <br /> qq <br /> C7 r <br /> CA <br /> 0 <br /> N Ir;l <br /> I� <br /> 10 <br /> O ti <br /> w_ <br /> a <br /> Z <br /> . <br /> 0 l; 'a <br /> .m <br /> mDa•� �• n n M <br /> CONDITIONS OF PERMIT: o ? Z m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o ` o 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. .0 E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Sii L) m <br /> 'n a m IJ <br /> PP (including Yaccompanying 1 Y y <br /> a, <br /> 1 declare that this application includin an schedule has been examined b me and to the best of m knowl- o a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i� S G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 uo <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> ON <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> - P <br /> n ': i 3 8 ,r; <br /> SIGN HERE i"GGt4 iY C `-'"`.�"°�-�'d'1c'G - --� •� N : € �'{ 8 <br /> (ai re of over or building contractor) ',;I�� L"Vv a <br /> ZONING ADMINISTRATO <br /> TOWNSHIP PERMITS MAY BE REQUIRED NOV - 3 1992 Xi isElan"" In <br /> vtwtwttnoo , m <br /> UI i'� 88888888 y <br /> i <br />