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� (z' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator r m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS '- 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the r <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0 <br /> regulations of the State of Wisconsin. !t lit <br /> y <br /> w <br /> OWNER / /e I Q yT,SQ r.,"J 0 h TELEPHONE L/6 _ !� G 3 <br /> n O <br /> tJ O p <br /> �7 <br /> ADDRESS �f�(� J / 2 <br /> EMERGENCY/FIRE NUMBER 17G ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR KJ S- <br /> TYPE <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° <br /> STRUCTURE/ADDITION USE: 6x� ( / /Q A/ o R <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) I <br /> o 0 O <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). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building W <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M f` <br /> dated by the owner. O o -� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a rn <br /> c <br /> �1 <br /> PLOT PLAN Z G <br /> O <br /> SPPsP�^ /'2&3-3 In <br /> C <br /> � r <br /> 7 ' <br /> P <br /> r — <br /> m <br /> o �iN y <br /> m <br /> z <br /> a <br /> m O,a.. g 0i a: M <br /> g� aIT nLm <br /> CONDITIONS OF PERMIT: a m y: Q c$ = C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o= 9 --I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. M: - m <br /> $ to O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- JZI i ^; C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- �^m": T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- if $ p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- i i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 $ <br /> (/ m A w <br /> SIGN HER " <br /> (sip r of owner o ding contractor) (date) <br /> ZONING ADMINISTRATOR $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED a N N N m <br /> $ $$ $$ o$ U) <br />