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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u -1 a o <br /> APPLICATION FOR - LAND USE - PERMITS 7 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes m ° <br /> g y application for a Permit for the work described and �2 w <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. y m <br /> w <br /> C <br /> OWNERTELEPHONE a �O <br /> MARK _nCEK a <br /> ADDRESS `7900 XEK%ES AV S StiITE 2130 MPLS, Ntl 55931- 110S- <br /> EMERGENCY/FIRE <br /> 105EMERGENCY/FIRE NUMBER ROAD NAME Old <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT( ): DWELLING UILDINGGARAGE/ACCESSORY STRUCTURE ADDITION p <br /> c) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVIS4QN ° <br /> 0 <br /> STRUCTURE/ADDITION USE:�� <br /> (Home�/Cabi ;Commercial BusinessBiiihroom, Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <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). <br /> 3. Show dimensions in feet of the following:(a) building to all lot tines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 ,H- <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 <br /> PLOT PLAN o <br /> 11111 1 <br /> C <br /> tqT-[7R C 415P (4 <br /> < <br /> o ; <br /> o <br /> 0 ^ y! <br /> O � IVA-ll <br /> J <br /> Iva ON <br /> 0 � � <br /> — <br /> 2 <br /> 1 <br /> 1 -- <br /> f <br /> m -0 <br /> '— G m Q$ MM <br /> W H <br /> CONDITIONS OF PERMIT: o � y,: � c� 30 5 � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o -Q : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. = N 6 2 o m <br /> o : [ IF : O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- Ri : 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- «.m fn M <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $` m <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- x <br /> plication.1 agree to permit county officials charged with administering county ordinances of ether authndzed,person to have o 0i <br /> access to the above described premises at any reasonable time for the purpose of insprtctron <br /> N � <br /> SIGN HERE ` p94 <br /> ZONING ADMINISTRATOR <br /> x x <br /> x x <br /> n <br /> TOWNSHIP PERMITS MAY BE REQUIRE ----. (Yo N N N m <br /> _ Oo $ $ S <br /> $ m <br /> ® KfA <br /> X <br /> a» <br /> tr <br /> 0 <br />