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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 -� <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. w m C <br /> c D <br /> OWNER TELEPHONE N , 7/S- 6 3 ,5 -30 7Y o <br /> m <br /> m <br /> ADDRESS �1 G Y S' �I GtJ eE NO/ 7- /- /S R.L7 <br /> !X � <br /> EMERGENCY/FIRE NUMBER - a 6�/ ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) GD 1/r 4 (J T 7 s C 7-J'�2 IP 1 T of lyk l y W ` <br /> CONTRACTOR WT-)g'.S LE k6 Cr` t, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <- <br /> N <br /> STRUCTURE/ADDITION USE: O � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o 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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). ° <br /> 3. Showdimensions infest ofthefoilowing:(a)bulldingto all lot lines,(b)bulldingto center line of road,(c)building I -J� <br /> measurement to the ordinary high water mark of lake,stream,or river. Q vv <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERIMr CAN BE ISSUED. 'II a <br /> KEN <br /> 71 Z Q <br /> PLOT PLAN ° o <br /> Sr7F 1471AC11'J� <br /> 1 N <br /> W o <br /> m <br /> o <br /> N <br /> ^ <br /> `jj j <br /> Z <br /> I <br /> m9 o c m m n a g <br /> . - am SS <br /> a2m <br /> a _ <br /> gm T� <br /> CONDITIONS OF PERMRg c <br /> : � a 'Z m ° .oAS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c ZQ <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. c ? O <br /> $ C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o o o : m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- yy,�m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- ': 75 om E p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g a $ <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O <br /> access to the above described premises at any reasonable time for the purpose of Inspection. ` ' m ' <br /> m vA <br /> : $ <br /> SIGN HERE (date) iX2 m <br /> (signature of owner b ding c nt tort Z <br /> ZONING ADMINISTRATOR <br /> TOWNS P PERMITS MAY BE REQUIRED 9.1 N��' m <br /> 8 $ 8 $ $$$ $ y <br />