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Burnett County 7410 Co. ltd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 <br /> d a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The u dersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and a <br /> 3 <br /> regulations of the State of Wisc nsin. a o Q <br /> m' <br /> n O <br /> OWNER �j, r � e / TELEPHONE o <br /> ADDRESS NNNN n1 m <br /> oc�o5Ler miu 55yCa ( G <br /> n <br /> EMERGENCY/FIRE NUMBER (J ROAD NAME �/eF k O� ( <br /> LEGAL DESCRIPTION (see taxrec ipt) i/CSec. T'JU)U • 12115 LJ <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/3UILDING_y__ GARAGE/ACCESSORY STRUCTURE ADDITION o ( / I <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o ` <br /> 0 - <br /> m r <br /> STRUCTURE/ADDITION USE: �'.LJ Wr_'. I o <br /> (Home/Cabin;Commercial B iness; Bedroom;Deck;etc.) z o <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of he following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordina y high water mark of lake,stream, or river. C <br /> 4. If separate plans are submi ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LICKATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a to <br /> PLOT PLAN See PaInt <br /> ANr� 4,C6 o 0- <br /> 9 <br /> 9 N <br /> SArldC t ' <br /> - -- fA <br /> CIO <br /> -- <br /> r P� C) <br /> iL <br /> N-W ib <br /> o <br /> Z <br /> r D <br /> �I <br /> A X ��2 � 0a� m <br /> _. pi£� �aH Qf <br /> m <br /> v m �, C g <br /> CONDITIONS OF PERMIT: < m2 T �' r� <br /> t. DRIVEWAY MUST MEET I RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F TQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' c �2 b: O <br /> I declare that this application( cluding any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> edge and belief it is true,corredt and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- �^m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `� is p <br /> motion I am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability whicli 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 ity officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 b <br /> m a m <br /> m <br /> SIGN HERE <br /> (anat of own r up6ing contractor) (datef <br /> o - X <br /> ZONING ADMINISTRATOR 8 ' <br /> TOWNSHIP PJRMITS MAY BE REQUIRED o g m <br /> o o $R $1 g (mn <br /> w x x <br /> 0 <br />