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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'a -4 0 <br /> -. <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require ems of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and t e laws and _ <br /> regulations of the State of Wisconsin. w m <br /> w <br /> !� n' n O <br /> OWNER K,,n / //�4Ht TELEPHONE S07 33Y- L o m <br /> ADDRESS[I / S /9V ,St /NY/C G✓ /1J�/ .S-S , <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME rQW e Y/ t <br /> LEGAL DESCRIPTION (see tax receipt) df S S rflh 1,6 !4/ es/%V /3 P,2sd <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 1/ 7 7 _ <br /> STRUCTUREIADDITION USE: PSnN.L+ SC 3/ yet 7-4ilti AMI/ /F"- <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> 0 v <br /> } <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 IN lorth (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). a <br /> 3. Show dimensions in feet of the following:(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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must b signed and X <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN E ISSUED. 3 y <br /> 71 .z `o <br /> PLOT PLAN _ G ,J Jrxc�`� a <br /> fC r E I Y i r t I� o <br /> �ZJ <br /> �9Cc � C 1 <br /> l//0 <br /> m <br /> � � o <br /> ��o <br /> w m <br /> o <br /> n <br /> y - _ <br /> m O c-N r D n O <br /> /V z�� g <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. oz m 55' <br /> = : Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f ' g <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> u� <br /> 8 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the be t of my knowl- l <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accurac of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- `� B <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 . $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am prov ding in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have m: 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 <br /> a a <br /> W <br /> SIGN HERE ` '^ <br /> (signat e o ownero ilding contractor) - <br /> e <br /> ZONING ADMINISTRATOR <br /> N. a <br /> TOWNSHIP PE MITS MAY BE REOUIRED <br /> ,I <br />