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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn 8 c <br /> APPLICATION FOR - LAND USE - PERMITS . <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 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> Y e V^ <br /> /7 C L J // C O 5) <br /> OWNER h C pl .J �Lc fj TELEPHONE /(o /rl Li� ��— $ O <br /> 11 �C T F <br /> o � <br /> n ,1 m � <br /> ADDRESS 7 3 6 X00 V er �/- �-/On/p V� /,(e �f -7 u <br /> EMERGENCY/FIRE NUMBER �y ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)`Of� /KS Al y/U 11 <br /> DVCONTRACTOR <br /> lye, dt t!-ah J f rk c 7`i oq r <br /> i <br /> TYPE OF PERMR(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION �p <br /> o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 'C. <br /> / oV <br /> STRUCTURE/ADDITION USE: G 6/ h a r <br /> S o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v (, <br /> c 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). 7A7- <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfleld (DF). - <br /> 3. Show dimensions in feet ofthe following:(a) building to all lot lines,(b)building to center line of road,(c)building -4 0 <br /> measurement to the ordinary high water mark of lake,stream, or river. 01 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 v <br /> N <br /> PLOT PLAN 7 Z <br /> P c <br /> w <br /> N <br /> O <br /> d <br /> O y <br /> w <br /> �J Z <br /> S <br /> f <br /> lid - a . <br /> CONDITIONS OF PERMIT: W o �t Z•: g c Y g�� ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = 5' 'E ? 812 ? i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° ! ' ` '-1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i ta'i f l i In <br /> ?i <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the bast of my knowl- <br /> edge and belief It is true,coma and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• E « rr a <br /> tion contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Infor- f $ S C <br /> Mellon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a pemit. I �t1': ? 8'� $ <br /> further accept all liability which may be•result of the County of Sumett relying on this information I am providing In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. . <br /> SIGN HERE <br /> (signahA of owner o(r"ildiing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> ,.I,8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ~�{fXY81i '$ m <br /> 88 88188 vi <br />