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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SM72 Office of Zoning Administrator 0 3 £ e <br /> APPLICATION FOR — LAND USE — PERMITS m = o <br /> N <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <br /> located ds shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 14 3 n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3. o <br /> regulations of the State of Wisconsin. <br /> n £O <br /> OWNER �. {I TELEPHONE � � S—,7 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / _ -Y / / l-r—, '�/— C{ e `� -Cr`_`. <br /> CONTRACTOR .O �C.t i C)`---1 <br /> TYPE OF PERMIT(S): DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION g <br /> n O <br /> 0 <br /> SANITARY PRIVY FILLIN�GG//GG,RADING CAMPING <br /> UINIT^/ SUBDIVISION <br /> STRUCTURE/ADDITION USE <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;otc.p Z <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate North (N). o <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 - C <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ON `0 <br /> c <br /> PLOT PLAN <br /> M IN o <br /> ' 3II , <br /> G <br /> ' � w <br /> 2. <br /> N <br /> � J <br /> 0 <br /> CONDITIONS OF PERMIT: C9c E 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. —N: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y� N 3 2 m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. }Y\ o : B ^ C <br /> o ' m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informa- <br /> m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o a O <br /> mation 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 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 r B <br /> m m <br /> m m o : <br /> SIGN HERE (/L. <br /> (si nature o wner or building contractor) <br /> ontractor) e... . `�-'- I E E x <br /> ZONING ADM TRATOR I �AIJG _neN,dN.' b <br /> RT <br /> MAY BE REQUIRED 1 O N a CTOWNSHIP PERMITS 600C00C <br /> (, R SerrT- 9--�-0! --- <br />