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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator dc c <br /> APPLICATION FOR — LAND USE — PERMITS d 3. <br /> TO THE ZON4NG 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 C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 OR <br /> regulations of the State of Wisconsin. o <br /> w m <br /> a 1D <br /> C <br /> 1 / \ / m <br /> OWNER L / 4 1 J4 hf F /f'fi9 �'1 G- TELEPHONE �.-� .��/ j a F <br /> L / / / / m <br /> ADDRESS .� 7 ✓k�-cI /y u 6 r5j d <br /> / / 1 <br /> EMERGENCY/FIRE NUMBER ; ROAD NAME �Gbq <br /> 4� <br /> LEGAL DESCRIPTION (see tax receipt) i <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE '--' ADDITION p <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> ]� <br /> STRUCTURE/ADDITION USE: Z o g <br /> (Home/Cabin;Commercial siness; Bedroom; Deck;etc. m <br /> o ° <br /> 9 <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 thefoliowing:(a) building to all lot lines,(b)building to center line of road,(c)building -q <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 <br /> dated by the owner. O e <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 rn <br /> PLOT PLAN Z <br /> s: <br /> / <br /> %�OIJi/ ��/�T6 i✓� �2�il0ve <br /> I <br /> O <br /> 6' <br /> o <br /> ° <br /> o <br /> y <br /> 0 <br /> Z <br /> z <br /> A o cm m o nRl� f m <br /> CONDITIONS OF PERMIT: a -tea' m C to o <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 6, 6 <br /> ' ? r� . . <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 21 N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. � : L7 O <br /> g : R C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m <br /> edge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 0 v N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I J 8 m 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. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above delilritied premises at any reasonable time for the purpose of inspection. m 8 <br /> V A N <br /> SIGN HERE <br /> (signature r uil actop (date) I a <br /> o <br /> ZONING ADMINISTRATOR <br /> WNSHIP PERMITS MAY BE REQUIRED <br /> pop . <br /> ' o <br /> 8888 888 <br />