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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w 0 O <br /> APPLICATION FOR — LAND USE — PERMITS 3. - <br /> o a <br /> TO THE ZONING 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 ; S' <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> o <br /> regulations of the State of Wisconsin. H m <br /> w � <br /> c <br /> n O <br /> OWNERRMANz-MSR TELEPHONE $&(, - g3gq f <br /> U O <br /> m_ m <br /> ADDRESS 2'33'18 J�REMci4 Rn - DRA/Buiey . l,Jl • S4230 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 � <br /> LEGAL DESCRIPTION (see tax receipt) <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION n o <br /> o <. <br /> r <br /> m <br /> STRUCTURE/ADDITION USE: o' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <br /> m <br /> } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O <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 r <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 1 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 v N <br /> c <br /> PLOT PLAN oSO <br /> n <br /> < —> <br /> mT <br /> C <br /> `" <br /> rA <br /> M w = <br /> C+{EID c <br /> V o <br /> 0 0 <br /> N <br /> O <br /> O � <br /> m <br /> I Z <br /> O c mN r n OD. <br /> D g� 2..a.0em <br /> CONDITIONS OF PERMIT. m ,z C. , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE, o m o: : -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �^ 62 1 m <br /> Ui 8 nE D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ': 0 i im C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- rn y w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- 13 B g ; m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $�$ 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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' mb m <br /> m v0 <br /> m <br /> m A <br /> SIGN HERE <br /> (signature 4f owner or building contracto e)L' - ? ' <br /> ZONING ADMINISTRATOR ',SF <br /> TOWNSHIP PERMITS MA BE REOUIRE ' m <br /> -- �'� a 8 'o N <br />