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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3, _TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q 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 3 n <br /> regulations of the State of Wisconsin. <br /> m' <br /> m O <br /> OWNER TELEPHONE 0 <br /> ADDRESS 7 T a1A i4✓/ y Cv . J yp&U <br /> EMERGENCY/FIRE NUM/BER ROAD NAME ' ' DRI 1&:: , <br /> I v) <br /> LEGAL DESCRIPTION (see tax receipt) .SW, $� I`1-- f��� "1 <br /> ('V Z4IJ /V',J i� I <br /> CONTRACTOR NV wG ��,J f, _ 23 J Z / ✓s: rl �t, ��� /1n �2 - fYJ-72- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE ADDITION 0 V <br /> � 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> 7 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) Z v <br /> o ° <br /> 0 <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfleld (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building .0 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I o cn <br /> c <br /> PLOT PLAN o n <br /> m o <br /> ZtYf y <br /> Divi e4a6kov'- <br /> 0� <br /> N <br /> v / <br /> 94 f <br /> }}wf3� (n c' Fc=tf o � loo g b'Cn00a$ m <br /> 11 6 <br /> CONDITIONS OF PERMIT: < m : ,z C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: I >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. b : <br /> o : a� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. m 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- toy« m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ is g : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o o <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 <br /> access to the above de38 <br /> scri emises at any reasonable time for the purpose of inspection. <br /> m <br /> m a A m <br /> lJi'�JN m 0 . <br /> TSG / �� w <br /> 0 : <br /> SIGN HERE �� <br /> (signs a owner o mg contractor) III,:,- (date) .3 E 8 ' <br /> ZONING ADMINISTRATOR v � <br /> TOWNSHIP PERMITS MAY BE REQUIRED U a N N N N'm <br /> L- o0 obb b iq0 J. <br /> 00000000 JT <br />