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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m c o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'o w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ^ 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 /> w m_ <br /> c m <br /> / ^ ^ - m O <br /> OWNER ��QAN O '�`y cC( ti TELEPHONE 7/ .f <br /> O m <br /> ADDRESS m <br /> o 0 J `D <br /> EMERGENCY/FIRE NUMBER ;t- 4 ROAD NAME /Le A � � (D <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR .t L t di <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> f r�S1�/✓"L7 V <br /> C. w r <br /> STRUCTURE/ADDITION USE: A-G"i S�N'�� ° o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) oZ p <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 (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. Q <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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ono N <br /> £/t7 Ic L44 Qat A d 2 c <br /> PLOT PLAN 44vStL <br /> l Q <br /> ox fn W o <br /> V <br /> � f <br /> �o o <br /> � N <br /> 0 <br /> d w / <br /> z <br /> r(o SzPrt�- <br /> NL poA,,.rflc(-� <br /> > Dap <br /> ff >m o c a_ m aam am 9 <br /> v m < °iCn o S � <br /> CONDITIONS OF PERMIT: <_. w_" 'z o - co <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 = 0 D <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,, In <br /> 0.8 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. v:t ^ E C <br /> 1 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. <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. I $ ? $ <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., iN <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O u, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 $ `� <br /> a <br /> A m <br /> SIGN HERE � : <br /> (signature of owner or building,contractor) (date) v : Fr <br /> ZONING ADMINISTRATOR <br /> NIR N+ tP ER(RHT <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N O N 8 O O m <br /> 8888888 in <br />