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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. IE <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and io <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 n <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. - o <br /> w w <br /> ^� n � w � _ <br /> OWNER 60 a. '(.J 1(�-1-r,� 0 TELEPHONE /S- a6 3 Q a_� a O <br /> ADDRESS R I a, RoK 7D 4 (2f�I^ �fr" � W (S ✓ t` o J � � <br /> EMERGENCY/FIRE NUMBER <br /> C / ROAD NAME �' <br /> UUUU V <br /> LEGAL DESCRIPTION (see tax r ,rte a -pQ,fin 0t- ,) 1, r r,7 , 1 J / _ (l Qj I /�/� !�/ di <br /> ^�. <br /> CONTRACTOR f `- C3 p <br /> V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESS RY STRUCTURES ADDITION p Ln <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT `0 O rT <br /> SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Z o <br /> 0 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). o <br /> 3. Show dimensions in feet ofthefollowing:(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 antl <br /> dated by the owner. O O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 N <br /> PLOT PLAN n o n <br /> 0 <br /> fA o (I <br /> CJ <br /> M <br /> 0 <br /> 0 _ <br /> O y <br /> LOar z . <br /> 0 <br /> Iyr 3at <br /> �0IfQ'�i <br /> m '- aii °+mOmm <br /> CONDITIONS OF PERMIT: m N:: Q CS 03 <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN SO DAYS OF PERMIT ISSUANCE. Z m'o': IQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f 0 T <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ud'i V7 : m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i 7 a .n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- of o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I : '8 <br /> oo <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- U. : ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O, <br /> access to the above described premises at any reasonable time for the purpose of inspection. o m C . <br /> 93 m ; : mss <br /> SIGN HERE w S : <br /> o : <br /> (siqiKatuof owner 11din9 contractor) --- <br /> L-- — r <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAYBE REQUIRED C,pi2 ? o N N N N N m <br /> 0000gSm <br /> 000 <br /> I <br />