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Burnett County 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Administrator m r m -01 ZO <br /> , <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <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 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. w m <br /> c m <br /> Q p n O <br /> OWNER !'O TELEPHONE DZS - 2_2 o £ <br /> o ' <br /> ADDRESS I 1 O ���+� Jl • r'lV 1 t �•-' i �. sy89� e �-{�—� <br /> EMERGENCY/FIRE NUMBER ROAD NAME l V v <br /> � 'Y <br /> LEGAL DESCRIPTION (see tax receipt) <br /> J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O M. <br /> l l <br /> `y^ 0 <br /> SANITARY /� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> STRUCTURE/ADDITION USE: � l"C�'Q.1.� r-JAifl Zwa>r i6 pc-'7m; T 4YYR(�(J{� <br /> (Home/Ca'bi�i ;Commercial Business;Bedroom;Deck;etc.) z v <br /> 0 0' <br /> 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 North (N). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). I4-7 o <br /> 3. Show dimensions Infest of thefollowing:(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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONS1rE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLAN ? <br /> � o n� <br /> mo <br /> ti i 1 <br /> a - ) <br /> In � <br /> � o <br /> I <br /> qqJ y <br /> N <br /> o <br /> w <br /> z <br /> I � <br /> i; <br /> m efN �rA � n ag a <br /> m �- v ' nm me m <br /> c D a a E= M <br /> CONDITIONS OF PERMIT: m- Q w o no.n' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e E ZQ 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZI <br /> 4 i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Iii ? A ' O <br /> g C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o i m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- � E i m y,1' T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inion- S Z <br /> pi 0 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 * 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- w <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have . . w ; <br /> access to the above described premises at any reasonable time for the purpose of inspecti <br /> A . : <br /> A : <br /> SIGN HERE t N ~ 8 . <br /> (Signature of owner or bull din co r t ri,� 11110) <br /> ZONING ADMINISTRATOR <br /> NN T <br /> TOWNSHIP PER ITS MAY BE REOUIRED - S o m <br /> 88 $ 88rn <br /> G <br />