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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; 0 0 <br /> APPLIC,ATION FOR — LAND USE — PERMITS 3. 0 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 m <br /> located as shown herein. The urdersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wiscoi isin. y m <br /> w � <br /> n O <br /> OWNER TELEPHONE f <br /> - Ifs �G6 - 769fr o <br /> w � , <br /> ADDRESS 6a G <br /> EMERGENCY/FIRE NUMBER 0 g ry ROAD NAME <br /> S�9/�d° ftIs w o4kQW LA-t 8' eSM V H Ps-z <br /> LEGAL DESCRIPTION (see tax rete pt) Ft1_y y,t519 do L l oo CSN Gov t-e 71) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o $ <br /> STRUCTURE/ADDITION USE: 1J <br /> Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o 1 <br /> 0 0 <br /> m <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). r <br /> 2. Show the location of thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinar F high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submit ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 O(y <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOGTIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> 1I Z `c <br /> PLOT PLAN 0 a <br /> m o <br /> C ' <br /> I <br /> ID F U o <br /> o <br /> 441 <br /> 0 <br /> J w <br /> tr Pa�b� 1 <br /> z _ <br /> � I^33ovC�S 1, <br /> bnNVrnr0 a* y <br /> 2. 4: WM <br /> ro 3) ompm <br /> Gi vim'-+..... !'a,n t, ...` c m z C w 0.(8-. 31 <br /> CONDITIONS OF PERMIT: < `B ; <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z F <br /> 2. REMOVAL OR CUTTING Cz TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. or : O sr'' m <br /> I declare that this application(ir cluding any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- •^w T <br /> tion contained in this applicati (including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ <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 cou ty officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described remises at any reasonable time for the purpose of inspection. <br /> N 9 N FA <br /> m : � <br /> SIGN HERE ✓ <br /> 61 (Sit ing contractor) (date) N <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REOUIRED1 . 9 bo <br /> o N <br /> X <br /> X <br /> I % <br /> X <br /> o x <br /> x <br />