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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 <br /> Office of Zoning Administrator rn Z <br /> APPLICATION FOR — LAND USE — PERMITS 3 ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned here 3 £ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> by makes application for a Permit for the work described and � �, g <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. 3 $ <br /> OWNER (( m m <br /> T° �G no� YS TELEPHONE as `I 735 o c m O <br /> ADDRESS I Z V1l. 't 4 f <br /> /all 6, <br /> EMERGENCY/FIRE NUMBER <br /> C/t;-io 2 ROAD NAM <br /> LEGAL DESCRIPTION (see tax receipt) I — <br /> CONTRACTOR P�e) S ;n µY1 ()� i (� r\ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING <br /> GARAGE/ACCESSORY STRUCTURE�- ADDITION <br /> SANITARY <br /> PRIVY FILLING/GRADING <br /> CAMPING UNIT SUBDIVISION " O <br /> o ° <br /> STRUCTURE/ADDITION USE: 2 <br /> ' 2 p1 r <br /> (Home/ abin;Commercial Business; Bedroom; Deck; etc.) o <br /> Z o <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ofD <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 drainfieid (DF). <br /> 3. SMeasurement to how dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> r- <br /> the ordinary high <br /> water <br /> 4. If separate plans a e submitted ed by anachite t engineer,builder,Contractor,etc.,the plans must be signed and I o <br /> 1A <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. O n <br /> PLOT PLAN 11 a ur <br /> z <br /> o P <br /> I <br /> �E p / <br /> s <br /> / A / N <br /> %i I� <br /> R o <br /> \ 0 y <br /> CONDITIONS OF PERMIT: <br /> O_ c m n D O <br /> A rid '- aaiamm <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. ZS.L.' Q <br /> Z REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o , <br /> € Wiz ' m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl g' _� C <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informs »G) <br /> tion contained in this application(including any accompanying scheduIn <br /> le)and I further declare that 1 recognize that this inma <br /> mation I em providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. i o B <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this t. I <br /> plication. l spree to permit county officials charged with administerin count ordinances or other authorized o <br /> access to the above d be premises at any reasonable time for the purpose of inspection. person to have <br /> ry O m v <br /> SIGN HERE 7 _ -- - <br /> (signature owner or building contractor) <br /> (date) <br /> ZONING ADMINISTRATOR <br /> g x <br /> TOWNSHIP PERMITS MAY BSEP e f994 <br /> E REQUIRE 1 `— ' «ter«+ « yr� <br /> � ---�� O M Mt5 V` In <br /> 000So In <br /> -- is <br /> N <br /> O <br />