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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S l m E o <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q a <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 _ B C, <br /> regulations of the Stale of Wisconsin. w m <br /> OWNER LflJ ,� �N�ST, TELEPHONE 6S�- .1� f <br /> w /U <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER °� l�' ROADNAME I <br /> l7� 1 <br /> LEGAL DESCRIPTION (see tax receipt) C07- <br /> 33 — W—1 <br /> CONTRACTOR f <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUR� ADDITION p <br /> cl <br /> SANITARY PRIVY FI NG/GRADING CAMPING UNIT SUBDIVISION G <br /> STRUCTURE/ADDITION USE: _�1`'fK t7(41 e-' 1)/X HV <br /> (Home/Cabin;Com6fercial Business; Bedroom;Deck;etc.) Z <br /> O <br /> o <br /> n <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). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfleld (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 -4 <br /> measurement to the ordinary high water mark of lake,stream,or river. G <br /> 4. It separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 e <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUBE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a 0 <br /> PLOT PLAN > OUf ? o n <br /> 9� <br /> N <br /> C ' <br /> � I <br /> d <br /> I <br /> --T- N <br /> O <br /> 3o / o <br /> -- '3 <br /> 33 <br /> A APO <br /> {lq <br /> — — -- - <br /> 3"3 ._ <br /> im <br /> CONDITIONS OF PERMIT: g Q C 8 g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E ': V 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" i r Q 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.1 acknowledge that I am responsible for the detail and accuracy of all informs- «o p i m <br /> tion contained in this application(Including any accompanying schedule)and 1 further declare that I recognize that this infor• }�' <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I k vi $i 8 <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 - - <br /> access to the above described premise at any reason time for he purpose of Inspection. <br /> SIGN HER <br /> I at re of o r or Itilding contractor) (date) <br /> �n i <br /> ZONING ADMINISTRATOR -�. 1 n [ i 8i <br /> In <br /> TOWNSHIP PERMITS MAY BE REQUIRED "85M55 8— m <br /> fS m <br /> m <br /> 888888188 ui <br />