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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator �U) ) '17'<l1 (Z <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> ermit <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Pfor the work described and w ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. 3 n <br /> a � w m <br /> OWNER � +� j, <br /> A <br /> /l/Yl del 1 TELEPHONE <br /> F <br /> ¢ O M <br /> ADDRESS \f S• I I S L 'C^I \�'\ (S /n <br /> nn <br /> EMERGENCY/FIRE NUMBER ROADNAME IF r 7F'.,I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR `.`..=J <br /> P �r �. u <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION O <br /> o <br /> o <br /> / /,j J 0 <br /> STRUCTURE/ADDITION USE: �, / OY� (jl� y r <br /> 0 <br /> (Home/Can,Commercial BiAmess;Bedroom;Deck;etc.) T <br /> z 0 <br /> 0 v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I M <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). r <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 antl <br /> dated by the owner. <br /> 00 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A3 <br /> PLOT PLAN Z <br /> o a <br /> O <br /> M <br /> 1 <br /> 0 <br /> �J CSL 1 �_J..1rl h(-1J 6.I_ -�<._i <br /> N <br /> 0 ^ lvi <br /> '1 <br /> Z <br /> Z <br /> I <br /> o c - N m o a 0 <br /> M 3 a m m <br /> CONDITIONS OF PERMIT. - a M <br /> v m = ' — a <br /> C m o � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F . T� ? <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U, f7 p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my kowg m c M <br /> ll nforma- <br /> edge and belief it is true,correct and complete.I acknowledge that am responsible for the detail and accuracy of ainI y, y M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor x' N <br /> mation I am providing will be relied upon by the County of Burnett hea pe $ M <br /> further accept all liability which may be a result of the County of Burnett relying on this information I Wisconsin in determining whether <br /> r to issue g rmi pI d, <br /> plication. I agree to permit county officials charged with administerinprovidinint a $ <br /> g county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. m FA g o <br /> m M : <br /> A a i <br /> SIGN HERE �� .)frr�f�'i�i` M N $ <br /> '� <br /> (si tur of own e o uilding contractor) (date) <br /> 0 <br /> ZONING ADMINISTRATOR <br /> 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED p <br /> W NN�N61 b1(p m <br /> N N N <br /> 00 <br /> O O m <br /> 9g $ $ $ $ $ y <br />