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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U 'a 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Zr <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. o <br /> N d <br /> N � <br /> I ff L � � C <br /> OWNER (',e ra L a K HQ I'�.SP h TELEPHONE �1/�� n '� ft <br /> �; I 1 O <br /> IE <br /> ADDRESS T(i.STYr1 � v <br /> EMERGENCY/FIRE NUMBER ROADNAMEn n e y, I n�e c�,,`/ 1 <br /> LEGAL DESCRIPTION (see tax receipt) (( /-O�-(- -'}, ��n{- Of 1>C)VI VIP- r I ake Sec-13-([J ! <br /> CONTRACTOR Yo�ff1 J=�)P I_S0 IYI� 1 -�— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p n--J-- <br /> SANITARY PRIVY FILLING/`GRA—DING CAMPING UNIT SUBDIVISION o, o <br /> J <br /> I� r y r <br /> STRUCTURE/ADDITION USE: l/1,p fC)ln - 7 0 <br /> (Home/Cabin;Commecial GBsedroom; J <br /> Deck;etc.) Z B <br /> o v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> ° <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 dralnfield (DIF). 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 -q <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 <br /> ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 <br /> 1I o N <br /> PLOT PLANA' Z a <br /> A <br /> m o <br /> C l <br /> r p r '7 R fn <br /> 1 <br /> m <br /> S� m <br /> o` <br /> x <br /> r y <br /> I <br /> /CC) Z <br /> i <br /> log) <br /> JJo c m m o a 0 V <br /> Q tr a � � 33 <br /> D � � <br /> CONDITIONS OF PERMIT: ✓"�k E "� q m < C m o a = c <br /> o <br /> 1. DRIVEWAY MUST,MEET DRIVEWAY WIDTH RE EMENT WITHIN 60 DAYS OF PERMIT ISSUANCE. Zm 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATIO ESTRICTED ALONG SHORELINE. o F J <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOW D UNLESS SPECIFICALLY PERMITTED. ' c5 C <br /> g F@ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o ?�m '� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- '" : a to m w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 11Q $ <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 a O P o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 8 <br /> o3 O <br /> T 9 u <br /> SIGN HERE c. C `r�(`7 ��Qe- <br /> (signaswe of ow�n"�y%gJ building contractor) (date) x <br /> ZONING ADMINISTRATOR � <br /> K: <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> N pN (pNII BC(pNpli pO <br /> 8 $ 00 $ <br />