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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator '; <br /> APPLICATION FOR — LAND USE — PERMITS m <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 r „ w <br /> g ag requirements W the o c ,� <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. m <br /> c o <br /> $ o <br /> OWNER L/AK q/ e � ,tN c✓�$ TELEPHONE 7i5 -a3-q— �3cf� O n <br /> ° <br /> � m <br /> ADDRESS 3/ t1S3 UJ �d L k d r� <br /> EMERGENCY/FIRE NUMBER 3 /y� ROAD NAME 4 �Ej J/i 4ri� �— <br /> LEGAL DESCRIPTION (see tax receipt) S cf -T y/ Oct GoJ L of j <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L7 <br /> SANITARY 'k- PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: !}AJ' .{ w° <br /> (Home/Cabin;C meBm;Deck;etc.) <br /> O <br /> Z o <br /> 0 0 <br /> m <br /> } <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 drainfield (DF). g <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building 84 <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in <br /> PLOT PLAN ° S <br /> O <br /> C �I ° <br /> (.� Z <br /> rA <br /> O <br /> O I (� <br /> d0 II,J <br /> 70 <br /> O y <br /> w <br /> Z <br /> 1 S <br /> 1 <br /> f <br /> s TLom8 of <br /> trr <br /> CONDITIONS OF PERMIT: o $_;: Z c 8 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i 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.I acknowledge that I am responsible for the detail and accuracy of all Informs- }}++ R <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this Infor. C <br /> motion I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I i $Y $ <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 premises at any reasonable time for the purpose of Inspection. r <br /> SIGN HERE <br /> (signature of own or U Ing y n ac oA (date) <br /> I /� <br /> ZONING ADMINISTRATOR8 E € <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> & >s <br /> 8888',88 <br />