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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m <br /> APPLICATION FOR — LAND USE — PERMITS . f <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> 9 by 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 b <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and It s laws and <br /> regulations of the State of Wisconsin. w o 2 <br /> b � <br /> OWNER T <br /> TELEPHONE bra-73d-ay�i n ( o <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER /l70 Ct ROAD NAMES <br /> 1 v� <br /> p , � <br /> LEGAL DESCRIPT N (s ace' 1)SoZS 3`� R `g(� �'L "38I8�SQ OSIc�O �� <br /> CONTRACTOR S�-�� + <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 1 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> I - _ <br /> I/ b V <br /> STRUCTURE/ADDITION USE: t — ii t'f'1 d✓l, 0 1 <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 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 (N),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 center line of road,I c)building <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 Igned and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN B ISSUED. in o u, <br /> PLOT PLAN Z `c <br /> n o <br /> C ) o <br /> �d0�'Y'I�bLof Q� tall � _ <br /> Al <br /> fir l. \ <br /> Tif <br /> u <br /> RM <br /> 10 X <br /> Z <br /> nd ktVAD <br /> to G k t ,n <br /> 0 gad m' " <br /> e <br /> CONDITIONS OF PERMIT: v 3:: c HEM <br /> M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z eu I U 1 <br /> o f = il <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �N a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �Mn : G) - m <br /> O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including an accompanying E '-fi' i m <br /> apo (� g Y ponying schedule)and I further declare that I recognize that this infer- � <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providi In this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized pe on to have <br /> access to the above described promises at any reasonable time for the purpose of inspection. Tt <br /> IASIGN HERE t l . 'h-B"1 5- V <br /> i o lowner or Iding contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> U _ <br /> y <br />