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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3' <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2m 6' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the q ,c, 'JCS <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. H m <br /> m <br /> O <br /> OWNER ELEPHONET7V/` <br /> V� ,nom t <br /> ADDRESS `-7j,S 57a1 �3') r ' I�L$ I�� SST <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 I <br /> CA <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n G) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 0 <br /> STRUCTURE/ADDITION USE: 54v�2-- ° � <br /> (Ho mo mercial Busi ss;Bedroom: Deck;etc.) z o @ <br /> O p <br /> N <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 G <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). ° <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <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 XJ <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'fI a rn <br /> 71 Z <br /> PLOT PLAN LL A o n <br /> PIofiMA-p C �� J N <br /> rn CA I cn <br /> 3 <br /> O1 c <br /> O - <br /> C W u <br /> n <br /> 0 <br /> I� <br /> N <br /> O <br /> 0 <br /> 0 y <br /> I� <br /> I � Z <br /> G <br /> m p,c.N r0 of m <br /> m = g� '- am c = M <br /> 13 b <br /> CONDITIONS OF PERMIT: ^ _' �' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. H- =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. "' m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 9-� ;' i aN a A: T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- O B 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 <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 have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. r o <br /> A N <br /> SIGN HERE <br /> tl (siS - u e of own e o building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> c <br /> TOWNSHIP PERMITS MAY BE REOUIRED NNNN N <br /> m <br /> ogN00000o <br />