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Burnett County 7410 Co. I d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 0 0 <br /> APPLI ATION FOR — LAND USE — PERMITS 3. 3 <br /> m <br /> TO THE ZONING ADMINISTRA R:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordiru nce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisco isin. m m <br /> k k o <br /> OWNER j/ rr,, E <br /> l c'-' P � `�. �� Cc.y�� 17r�n "k L TELEPHONE �(,l"L.� H ' � L!,$t ^I � <br /> ADDRESS [l� O m <br /> ( m <br /> ��-) i `-( T <br /> n,( >rt.Cet �✓Z <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME r+`/n✓ L { <br /> LEGAL DESCRIPTION (seetaxrec(ipt) r)�� ,_ - �Zk• <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> Y o <br /> SANITARY PRIVY CAMPING UNIT SUBDIVISION o <br /> I d �LrY r <br /> STRUCTURE/ADDITION USE: 0 o <br /> (Home/Cabin;Commercial Business; droom;Deck;etc.) Z o <br /> o � <br /> 77- <br /> m <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 w II (W),septic tank (ST), and dreinfield (DF). o <br /> 3. Show dimensions in feet of he following:(a)building to all lot lines,(b)buildingto centerline of road,(c)building <br /> measurement to the ordinaiy high water mark of lake,stream,or river. <br /> 4. If separate plans are submi led by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a N <br /> c <br /> Z v <br /> PLOT PLAN o n <br /> m o <br /> CI <br /> w <br /> m <br /> J <br /> m <br /> o <br /> M&I oC,7L• 1 �� 0 <br /> o <br /> R. <br /> o <br /> m <br /> z <br /> I <br /> f <br /> Q0 D g� a m e c M <br /> CONDITIONS OF PERMIT: ^ < _,: 42 �`� m T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMF ISSUANCE. a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t,`- =N I : M <br /> Xk N' <br /> 3, NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u' : 25 ig r2i 1 m <br /> los <br /> g g� ' I C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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. N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ( B g ; p <br /> mation 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 in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have : O N v <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m - m <br /> 3g : <br /> M : b A m <br /> N O <br /> SIGN HEREa `8 i <br /> lk gnature of ow er or building contractor) (data) a' <br /> ZONING ADMINISTRATOR rn %8 -- <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u� moS U) <br />