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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c ' c c <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located'as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <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. N m <br /> N <br /> C <br /> o <br /> OWNER TELEPHONE <br /> ., 1 O <br /> ADDRESS y/� 271 WE 13 <br /> / 1. 11 , q%q-3 '3 <br /> EMERGENCYv/FIRE NUMBER I1pi//6 F. IAl '� f U ROAD NAME �A Ip !'�/JOt1L1VlC Q,/1 _ <br /> LEGAL DESCRIPTION (see tax receipt) 777/1 11` IC V IV V J I\V <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> m � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <br /> m <br /> a <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). o <br /> 3. Show dimensions infeet ofthefollowing:(a)buildingto all lot lines,(b)buildingto 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 X <br /> dated by the owner. 0 c <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a y <br /> c <br /> PLOT PLAN n o n f�` <br /> MDQ <br /> C ) <br /> N <br /> ow C � <br /> i N <br /> 0 <br /> ° <br /> 0 <br /> N <br /> Z <br /> Z <br /> G <br /> m o c . m m m n <br /> R a 9 <br /> CONDITIONS OF PERMIT: 0 :5. ,2 m o S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o T� <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. np : m �2 C <br /> 8 : 6 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m `� 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- w m w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8,'m° N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g <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. N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to hav <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m a A <br /> SIGN HERE /PLr,fJ <br /> m <br /> _ « m <br /> H a . <br /> (siiggr7ature of owner or buildi co ra , ' (d e)- [ [ x <br /> 1`�3D <br /> ZONING ADMINISTRATOR <br /> JUN 2 91992 <br /> TOWNSHIP ERMITS MAY BE REOUIREDI H N N H N ' <br /> arno <noo � M <br /> _.. gg gg gg 8 to <br />