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691 <br /> - "Api <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m mo 0 <br /> o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The agrees undersigned that all work shall be done in accordance with the r m c � % <br /> 9 a9 equireme sof the 3 g <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the It ws and _ <br /> regulations of the State of Wisconsin. <br /> m g <br /> I m O <br /> OWNER �� t%Aa nit ,(/Lt. TELEPHONE . 12Z ,k . L m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER fl c"r fi ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> (Ily L , T 2 ! C c t <br /> J Y <br /> CONTRACTOR / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 3 0 <br /> SANITARY PRIVY7 <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> r <br /> STRUCTURE/ADDITION USE: G 'orll c ^-C o °— <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _ l\ <br /> P v <br /> 3 � <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 Non (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to centerline of road,(c) ullding <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 sig ied and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE E SUED. 7I o y <br /> c <br /> PLOT PLAN tS I A o a <br /> Yl C <br /> r a <br /> C m <br /> 0 <br /> 2� <br /> g <br /> N �n <br /> /O r !� �E lS g <br /> y CB N� �20 <br /> � r <br /> o <br /> 0 J , — <br /> l Onlr.� 0'3� Y'ery+.r l <br /> ON1 yC . M,' t o l .r )� <br /> $•� 3.ae <br /> fin <br /> CONDITIONS OF PERMIT: <br /> Zi Z1. DRIVEWAY MUST MEET WIDTH <br /> 2, REMOVAL OR CUTT IN OFIVEWAY TREES AND VEGETATIONENTS IS RESTRICTD ALONG SHOREL NEWITHIN 60 DAYS OF PERMSQ <br /> IT ISSUANCE. p F rn 30 <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> qq e : O <br /> V,%i 5 i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl 0 : . <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of at informs- a m is m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that I his infor- _ i 8 B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap• x <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE wl u .o <br /> (signature of owner or building contractor) (date) g <br /> xn <br /> r, t <br /> ZONING ADMINISTRATOR x <br /> TOWNSHIP PERMITS MAY BE REQUIRED +o N N N m <br /> S8o <br /> x$X X X <br /> X x <br /> 0 <br />