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Burnett Cos.+nty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator `J0` m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C� <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. - <br /> N N <br /> N � <br /> OWNER u,�d J. Piro he-VA v TELEPHONE (012_ (-('J y��y(,j o a <br /> ADDRESS 1' <br /> So�I� p �wpy 1.1, 2� - L e�jl4rw&?e? 5-5 _ <br /> EMERGENCY/FIRE NUMBER 1 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) osl✓t �/,U S- o 0'�� I . <br /> F-U <br /> CONTRACTOR '1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> >ju� 1 <br /> STRUCTURE/ADDITION USE: <br /> (Home/C m; Commercial usiness; Bedroom; Deck;etc.) z <br /> o <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 the following:(a)building to all lot lines,(b)building to center line of road,(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 signed and y <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSME VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on v 0 <br /> PLOT PLAN (�(r-c�rS o a <br /> (A <br /> 1 5ee m N <br /> � . o <br /> A_i H <br /> r' aS m -f--Stet%i S . To 1-k. 9-1 <br /> a ' <br /> I <br /> [� o <br /> z <br /> 1 1 <br /> r r �roP%Sc- C <br /> r jt: <br /> I f 'a 62oam m <br /> CONDITIONS OF PERMIT ,a 3 g Z C, �� i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f .Q -4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r» M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i N 2 m <br /> o : [ B [ D <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl-edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- v.m m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,`� ii] g p <br /> mation 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 i i n I am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinance tit to have i O N p <br /> access to the above described premin at anreasonable time for the purpose of insp i oo <br /> m <br /> q ' <br /> SIGN HERE <br /> ( are of owner it"ding contractor) te):;;;j I Ni <br /> Fr: <br /> ZONING ADMINISTRATOR S <br /> N4 r r�N� T <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N N U N N O m <br /> o' rn <br /> /ef,5e cadv)Se,-Foran00000 <br /> cckt, Ff oro.( -P—yPej0' <br />