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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> m <br /> APPLICATION FOR — LAND USE — PERMITS ° <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 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. m m <br /> OWNER TELEPHONE n ' f <br /> K � t� T ZEIE K1Lj�Vl4l n f� tEmP. i �irs87U53�6 m <br /> 9 J3 <br /> ADDRESS t Z-5 -L' NS <br /> /- a <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> i <br /> LEGAL DESCRIPTION (see tax receipt) r� I , ',. a SC'-c-aS <br /> 1\oN1 \ <br /> CONTRACTOR VC-R&I E /77. )97-ZE)e- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE X ADDITION o n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> STRUCTURE/ADDITION USE: ` orn ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Cb ? <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 151 <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (DF). .-4 <br /> 3. Show dimensions in feet of thefollowing:(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. Alt <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and )T <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o rn <br /> 7I Z c <br /> PLOT PLAN <br /> C IQ o' <br /> 15- T— o <br /> r z4 051 4 1 �� 'r MI')r KFdt�7w'7` N <br /> Ri N (3 tz' rYwue bArI sF m I <br /> N z� 36: <br /> Z <br /> I <br /> W r a F <br /> M <br /> CONDITIONS OF PERMIT: o `c° Z •2 Co m T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a E $•z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c 31 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including an accompanyingschedule has been examined by me and to the best of my known- m o€ C <br /> PP ( fl Y 1 E o p 0' : 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- Qj = yy!!m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 7i a P ; o <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 8 <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.I agree to permit county officials charged with administering county ordinances or other authorized person to have t ; O n�o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 11 m o <br /> m 3 A <br /> mi € mnm : <br /> M3 <br /> N w <br /> A : <br /> SIGN HERE l - �� ' <br /> (sig re of ow r uilding contractor) (da e) 8 s [ <br /> ZONING ADMINISTRATOR ' '• ' <br /> r: N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ! 91 N N 0 • m <br /> 8888888 <br />