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Burnett county 7410 Co Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a A a a <br /> APPLICATION FOR — LAND USE — PERMITSm 3. <br /> O <br /> TO THE BONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i5 v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the V� <br /> Burnett County Land Use Ord nance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. <br /> m' <br /> m O <br /> OWNER F I TELEPHONE <br /> ADDRESS %3 RL ST- MQ RSLE 1_LES it ZL- . I J -�Ljj V� <br /> EMERGENCY/FIRE NUMBER 642-1 ROAD NAME Lj�l L <br /> 1 J <br /> LEGAL DESCRIPTION (see tax r ceipt) (X; o <br /> 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN /BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION G) <br /> o _ <br /> H 0 <br /> STRUCTURE/ADDITION USE: ( `f" / l3Y ^ o' ° <br /> (Home/Cabin;C mercial Business; Bedroom;Deck;etc.) Z <br /> 00 <br /> 0 <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLNN DRAWING: (Aerial or top view) <br /> 1. Show the location and site 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 thefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordir ary 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. Ino cn <br /> c <br /> PLOT PLAN o n <br /> fn , o <br /> C <br /> M <br /> c <br /> n <br /> 0 <br /> 0 <br /> N <br /> O <br /> J <br /> 0 <br /> D <br /> N <br /> _— Z <br /> 9 �n W _owg>DO M <br /> g a F fn <br /> 33- 6 W e. <br /> CONDITIONS OF PERMIT: ? m S.: R C6 0 ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m 5 -Q 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. omia O <br /> o : a 06 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : ^: ' G): : M <br /> edge and belief it is true,corr ct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : d.m'^: m <br /> tion contained in this applica ion(including any accompanying schedule)and I further declare that 1 recognize that this infor- G V 8 is 8 1 p <br /> mation 1 am providing will bit relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 10� o <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 N o <br /> access to the above described premises at any reasonable time for the purpose of in ection. T 3 6 RL i0 <br /> 0 . <br /> SIGN HERE - <br /> (Ii6riature of owner or building contractor) 1 ate) <br /> ZONING ADMINISTRATOR ,'Yl �� <br /> APR <br /> TOWNSHIP PERMITS MAY BE REOU j N N N p N T <br /> 1. <br /> '� o0 08oi7 <br /> iN <br />