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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Q) M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS m 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m '( i <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3_ a <br /> regulations of the State of Wisconsin. r o <br /> m � <br /> m <br /> ban Las I�U TELEPHONE — 11 c m F <br /> m <br /> OWNER n <br /> o ' <br /> ADDRESS`' 1\0bcr�—, uja( P,-L a-den I t—T� sys d m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> yl Jl/I <br /> LEGAL DESCRIPTION (see tax receipt) r <br /> CONTRACTOR ( <br /> �1k R <br /> TYPE OF FERMI (S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> (tel <br /> STRUCTURE/ADDITION USE: A I-�fi?d r) o o <br /> (Home/Cabin; Commercial Business; B room;Deck;etc <br /> z o <br /> o v <br /> m <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). U) <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). (J1 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building - w <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o m <br /> c <br /> PLOT PLAN ^ ' n o n <br /> See -�a C hro( P)1� Pc c <br /> N <br /> rn � <br /> C : <br /> N <br /> )LJ <br /> 0 <br /> IRc <br /> N \N\ <br /> O <br /> 0 <br /> O � <br /> H <br /> I <br /> Z <br /> N z <br /> e L <br /> o c 0 m n a F m <br /> 1 > 0 a m <br /> CONDITIONS OF PERMIT <br /> A g e go 0 m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 F a T'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = N ' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' m " C <br /> $ c : <br /> a , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m `� in <br /> edge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all informa- w a fn O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that thisinfor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 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- %IN <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O v, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ $ <br /> m a A m <br /> m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) [ }. <br /> o ; <br /> ZONING ADMINISTRATOR V 141�-;l�� 8 ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^N N`"`"w m <br /> N <br /> 00. O u 8 8 `9 m <br />