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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 548721 <br /> Office of Zoning Administrator v�� �v a Z <br /> APPLICATION FOR - LAND USE - PERMITS ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permft for the work described and 3 = ` <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c c <br /> Burnett Couny Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and N <br /> regulations of the State of Wisconsin. 3 a <br /> q� N <br /> OWNER dJR 12 GL�.t� A/ <br /> C <br /> ADDRESS � ���PJ TELEPHONE 1�6 ._{l v p <br /> Z � j!3 G� �'41� !i° BSTEv r6� <br /> EMERGENCY/FIRE NUMBER ROAD NAME 4x !� ) <br /> Y' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> _yam, <br /> CONTRACTOR SCeZ j-7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING <br /> GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING <br /> CAMPING UNIT SUBDIVISION 0 O <br /> 0 <br /> p o < <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin, Commercial Business, Bedroom, Deck;etc.) o <br /> m <br /> z o <br /> o c r- <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 <br /> drainfield (DF). North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and <br /> 3. Smeasurement to how dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> gh <br /> ter mark of lake, stream, Or river. <br /> 4. If separate plans tare submitted he ordinary iby naarchitect,engineer,builder,Contrator,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PER CAN BE ISSUED. O O <br /> 0 <br /> PLOT PLAN ? N <br /> 1o �� � <br /> r 0Z <br /> �� , fa m <br /> � C o <br /> its <br /> \ <br /> 2g � <br /> 1 <br /> r7,5 <br /> is 0 <br /> 0 <br /> talo <br /> � a <br /> .Sn* <br /> '0 <br /> �c �r cDi a <br /> n <br /> CONDITIONS M PERMIT: m =�,� a m a m m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. z 0 o' ? �)Q 1 � i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 F , - <br /> v : E)2 ; m <br /> $ <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knows- : ' <br /> o biC <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a m w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied u y y determining Pe '�� m <br /> further accept all liability which may be a resultof the County frBurnettett relying 1on n in esinformation 1 am providing en this rt. I o a o <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized 0 o <br /> aP a <br /> access to the above described premises at any reasonable time for the purpose of inspection, person to have <br /> N 0 m <br /> m O O <br /> SIGN HERE <br /> o <br /> (signature of OwnjeE.Qr building contactor H <br /> --�T (date) ISE E <br /> ZONING ADMINISTRATOR \ J1 )( 0 <br /> 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ;« «+j«. «,d, T <br /> ONVNi � N gNm <br /> 000000PfT1 <br /> 00000 000 <br />