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�l i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rp ; -. o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q a ° 00 <br /> located as Shown herein. The undersigned agrees that all work shall be dole in accordance with the requirements of the $ C� <br /> Burnett Courtly Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ e <br /> regulations of the State of Wisconsin. m <br /> a v <br /> OWNER J eY TELEPHONE 71J ��/� 5/ C 0 <br /> m <br /> ADDRESS G Q l� c/p / <br /> T/ { �c G s 4 c 5� <br /> EMERGENCY/FIRE NUMBER 6Q q/ ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) /G <br /> &10 � Q <br /> CONTRACTOR w e caws') L <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION » ° <br /> C It. <br /> L y r <br /> STRUCTURElADDITION USE: C f i yob 7 J�ij Ya o °» <br /> Home/Cabin;Commercial Bu ness;Bedroom;Deck;etc.) Z v <br /> o ° <br /> v <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), 1 o O <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building O <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 —� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I c y <br /> PLOT PIAN !`__--- ----- - -- _ P LL o S <br /> 0 <br /> C 1 ° <br /> q4 <br /> SU <br /> I <br /> o v <br /> 1 U 1 y <br /> 2 <br /> v \ <br /> I <br /> CST) <br /> 0 <br /> Z <br /> P� <br /> �U <br /> 100 <br /> J lV 0 �'FL OA MMMM <br /> CONDITIONS OF PERMIT: a g� , o. — <br /> .6, � c5S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIR MENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> f € w. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATI IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. J� r^: '• O g m <br /> Er C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- � o <br /> c E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- N 0 N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ 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 Sumett 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 <br /> access to the above descrl premises ry reasonable time for the purpose of Inspection. <br /> T <br /> y N <br /> SIGN HERE <br /> signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED 't <br /> m <br /> 8888888!8 UP <br />