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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � `m'� <br /> 1 E <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> TO THE ZC,.NG 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 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. m o <br /> OWNER �//1✓ /1a(��}��. / TELEPHONE 2y(, . 77&1 n O <br /> ADDRESS & 33� /02 ZA10. SLVn � <br /> .0 _ wtw 12icNMoo W S4bil <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) I <br /> CONTRACTOR I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY nF,I/LUNpG///GR�ADING CCAAM/PIIN�G UNIT—/�,/¢Q—y, SUB�DDIIVIIISIIONN—►,1�—,\}\\- o <br /> 0 <br /> STRUCTURE/ADDITION USE: � g <br /> (Home/Cabin; mmerc(el Business; Bedroom;De4y;etc.) Z <br /> 0 0 <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). J <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). G7G <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building U <br /> measurement to the ordinary high water mark of lake,stream, or river. U� tJ <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 / <br /> NOTE; BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> PLOT PLAN z <br /> o n <br /> Sb <br /> m 0 <br /> 0 0 <br /> C <br /> LIJ <br /> (, <br /> 0 w <br /> 0 <br /> J��'' <br /> ✓V\N 1 <br /> O <br /> 0 <br /> v � <br /> N <br /> r <br /> Z <br /> t D <br /> O,c�< ymtDi acm <br /> m = nm 4-m m <br /> �`G 2 <br /> CONDITIONS OF PERMIT: v m <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN r>D DAYS OF PERMIT ISSUANCE. Z0 o ' -.Z —4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p F n (n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- u us <br /> O ]7 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a o p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <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 haveO N O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> bo : <br /> m 300 <br /> SIGN HERE <br /> (signs re of owner Idino9dintrac (date) <br /> Fr: <br /> ZONING ADMINISTRATOR <br /> TOWNS P PERMITS MAY BE REOUIRED m <br /> o N � Nm <br /> 0 o00 f// <br />