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Burnett County 7410:Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 c <br /> APPLICATION FOR — LAND USE — PERMITSs. <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w J <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the u = —n <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and S a <br /> regulations of the State of Wisconsin. �, m <br /> w m <br /> C <br /> OWNER '�l�ICJ I �1`Ce� TELEPHONEo E <br /> hCU� I I 1 h 1` )�,��,,, 1,�-�— m m <br /> ADDRESS ad I [-7j GI l 1 J�j -�L.C� IPS. VUJ� {� - e <br /> EMERGENCY/FIRE NUMBER ROADNAME h•l!y not <br /> L 43 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> u <br /> CONTRACTOR le) _ NO <br /> TYPE OF PERMIT(S): DWELUNG/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING 91flIT SUBDIVISIO o <br /> ° 1 �i <br /> 9 m r <br /> STRUCTURE/ADDITION USE: 7 1! - ���liT 1 ,I o <br /> (Home/Cabin; mmercisT Business; Bedr- m;Deck;etc.) Z <br /> o ° <br /> a <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 North (N). <br /> 2. Show the location of the well (W), septic tank (ST), and drainfleld (DF). 5 <br /> 3. Show dlmenslons In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building 1A <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 M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '111 a N <br /> PLOT PLAN A ? n <br /> C <br /> a � <br /> fA <br /> u, <br /> N <br /> ° <br /> 9 � <br /> w <br /> UJ <br /> Z <br /> i <br /> FL 2.a <br /> g� 33 <br /> CONDITIONS OF PERMIT: .Z CS <br /> g.w. <br /> M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c SQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 2� <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- vv " « •+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i4 is C <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $1 8 <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- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T 4v* <br /> M <br /> SIGN HERE «E <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR `Tm���tian ' 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> 888888,818 a) <br />