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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (0 -0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'z <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m d <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin, w m <br /> OWNERS �(•ras' �S TELEPHONFj` /S_ SE7„ 3G ��j/ <br /> ADDRESS 60 d37 <br /> RwZf <br /> ,=- C% t '�at�1h SdY3fa <br /> EMERGENCY/FIRE NUMBER/� / ROAD NAME d <br /> Ttt�lN�r�CU, SS <br /> LEGAL DESCRIPTION (see <br /> tax receipt) aS/n V/.O �� <br /> CONTRACTOR !�� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o ^' <br /> SANITARY PRIVY FILLING/ DING CAMPING UNIT SUBDIVISION o ° <br /> Z <br /> 0 <br /> r f I w r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; eck;etc.) Z a <br /> K f— o <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 /> r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 <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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. G o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 ur <br /> PLOT PLAN /I/ 0 Q <br /> i <br /> o n <br /> m w o <br /> m �A <br /> S� 9 <br /> is �s lbfr N <br /> o <br /> J <br /> m <br /> SN3L <br /> Z <br /> 2. <br /> CONDITIONS OF PERMIT: <, Z `� g rc <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = e `z 4 <br /> o E <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i <br /> o 62i 1 rn <br /> o : ig <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m B C <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 n T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. o : p <br /> motion 1 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 providing in this ap- <br /> plication.1 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. T 3 0 3�'c <br /> m A N <br /> SIGN HERE '^ g <br /> (signs of owner or b 'Iding contractor) (date) <br /> ZONING ADMINISTRATOR �' $ <br /> Q N N W N N H -n <br /> TOWNSHIP PERMITS MAY BE REOUIRED o y u u u m d n m <br /> In <br /> C$ $ $ $ $ $ g0 V) <br />