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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for 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 m m .� <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> 0 <br /> regulations of the State of Wisconsin. w °: <br /> c <br /> O <br /> OWNER TELEPHONE �� yI/ - <br /> v�O b _1ZM�-11 m <br /> m <br /> ADDRESS L}L� .� I.NOC7I�J'L. St. P mnl ��n- &)Y1 SW q-3 m <br /> EMERGENCY/FIRE NUMBER J 7 <br /> 3 3 })/ I ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR JJJ <br /> TYPE OF PERMIT(S): D ELLI /BUILDING GARAGE/ACCESSORY STRUCTURE /Y ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o <br /> c D 4 J Q 0 <br /> o <br /> STRUCTURE/ADDITION USE: S i Z � <br /> (Home/Cabin;Corrinficial Business;Bedroo n;Deck;etc.) Z o <br /> o <br /> 3 <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). I r <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> n <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 3 rn <br /> 11 Z `v <br /> PLOT PLAN n o a <br /> a�f > c <br /> a � <br /> M <br /> _DwJElliAfY <br /> /�° <br /> 0o nWC4 S <br /> J <br /> N <br /> tS/sd <br /> �a �y <br /> r G3 f-4 . <br /> 7L <br /> ------� <br /> Z <br /> 0o � � md � a � <br /> m F£ n 2 '" y <br /> ic <br /> CONDITIONS OF PERMIT: c '^ m ° 0. `n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT IS ANCE. o F 0 r� 9 <br /> _ � : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED." O <br /> m C <br /> (Z $ n , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m G) _ m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- J m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this info(- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g g <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 m N B <br /> access to the above described premises at.4,ny reasonable time for the purpose of inspection. <br /> r 9f <br /> SIGN HERE <br /> (signature o owner r i ding con r to p ( ate) ao x <br /> ZONING ADMINISTRATOR <br /> H . <br /> TOWNSHIP PER S MAY BE REQUIRED u "n '`R o , o gm <br /> 8888 8 <br /> 9 ) <br />