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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (A A o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. — <br /> m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m ` <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> OWNER B 4j r�j/ 146 jcl TELEPHONE <br /> l/ F <br /> m 1D <br /> ADDRESSm <br /> T-)0 . <br /> EMERGENCY/FIRE NUMBER D NAME IS14( L FJroC'j�' Rt,,.J 'C <br /> LEGAL DESCRIPTION (see tax receipt) S W %[(' E� S- rS' "�' '3q �2.. L.-) �{ r� <br /> Z `Y >1 "\ <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING _ GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> J f- <br /> �' r <br /> STRUCTURE/ADDITION USE: ,k <br /> abin;Commercial Business;Bedroom;Deck;etc.) IZ v U <br /> 0 <br /> V1 <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). r ) <br /> 3. Show dimensions infeet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building -q <br /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 'A <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o rn <br /> PLOT PLAN 0 Q <br /> O— n <br /> All -; X m y `� <br /> m <br /> l/ <br /> ° <br /> 0 <br /> J <br /> N \ <br /> O <br /> J <br /> �n <br /> f J ILD ' <br /> I <br /> f <br /> c� + CCDi aCm <br /> m -i£� 2.a0 g+m m <br /> D-' rf -. <br /> m <br /> CONDITIONS OF PERMIT: = $ . .2 CS Jo ,J 0 Ta <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f 0. 6 m�`2 : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o l ° O <br /> a ' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- H y a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 13 $ ; p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 91 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the ve described premises at any reasonable time for the purpose of inspection. m 3 'oo <br /> O : m A m ' <br /> M O : <br /> SIGN HERE P,L, � r - <br /> (signature of owner or building ntrc 0 ( te) <br /> ZONING ADMINISTRATOR <br /> TO-100 <br /> � �TOWNSHIP P MITS MAY BE REQUIRED a � '8 m <br /> m <br /> 0 000M <br />