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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> >E <br /> APPLICATION FOR - LAND USE - PERMITS m _ <br /> TO THE ZONING ADMINISTRATOR:The here undersigned g by makes application for a Permit for the work described and Q rn <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ' O <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and j $ <br /> regulations of the State of Wisconsin. w m <br /> w m <br /> OWNER (j,ro S�y` TELEPHONE 3S -;l3 <br /> \\\ m J <br /> ADDRESS ( � I c o ( LJ <br /> g n1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME PIC-Pin Ro <br /> PwNt c4 6v.. u Scc 'rorrn o <br /> LEGAL DESCRIPTION (see tax receipt) ) <br /> C e t w <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> V c� <br /> SANITARY /V PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> /gyppI/' o <br /> �,,I Q�WI_ N <br /> STRUCTURE/ADDITION USE: U7 U.�� J � o a <br /> (Home/Cabin;Co merciel Business; Bedroom;Deck;etc.) VZ <br /> O 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 Nort (N). <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). 0 <br /> 3. Show dimensions Infest ofthefollowing:(a) buildingto all lot lines,(b)building to center line of road,(c)building yl <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 sl red and 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE KISUED. 'N c q <br /> c <br /> PLOT PLAN o n <br /> o <br /> I C <br /> Y j� <br /> b�,s, 5 -i -yews <br /> IN ICS <br /> p r kt Y,✓49r/)J11e-1(1 v ~ <br /> Z <br /> gD� m <br /> —FL ae _ <br /> CONDITIONS OF PERMIT: m <br /> R. <br /> ,Z C g g 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �O i 'lr.Q 1 i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r= <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U1 i i O C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- In <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that inis infor $ i <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing n this ap. OrE i ' <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (signs of wner or ng contractor) <br /> ZONING ADMINISTRATOR4-11 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 88 8 8 8 y <br /> 9 <br />