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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 1_ E <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 requiromery s of the m c lr <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. / o <br /> m � <br /> _ J Il c <br /> OWNER�����1 � �i���✓/ ./� TELEPHONE �Jv 71, T3 £ <br /> ADDRESS 5-9:9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) r //7%/C� .�G 40'• S <br /> 1 <br /> CONTRACTOR 4/41s <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE V ADDITION p <br /> m + <br /> SANITARY PRIVY FILLING/GRADING 0 <br /> /ADING CAMPING UNIT SUBDIVISION o <br /> K / U/ , <br /> STRUCTURE/ADDITION USE: Qp � / 7%j � /I,J� �✓�'�D.fi�iJA ,Tbi✓� �A irl� g _ 1,2" <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> -75 <br /> Z o <br /> o v <br /> � r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all ex nd all new buildings (NB) and Indicate North (N). <br /> 2. <br /> 4. su m e by an architect,engineer,builder,contractor,etc.,the plans must be siged and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. an aN <br /> PLOT PLAN z <br /> l A o n <br /> C At CSC'' "c% a s r-) <br /> 0 C- <br /> i o <br /> =ed <br /> SL!':i c- � z <br /> n <br /> I <br /> L A/C <br /> ss� m <br /> CONDITIONS OF PERMIT: o 2;: c g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. SE <br /> Z o ': ffi Z SE <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o N 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn : V7 i m <br /> 2 ; D <br /> PP (including Yaccompanying 1 Y <br /> I declare that this application Includin an schedule has been examined b me and to the best of m kno �1 C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all nforma E m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor1J - -- — ; p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a mrmit. <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-1 <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have) <br /> access to the above described premises at spy reasonable timejor the purpose of inspection. <br /> 9 In <br /> SIGN HERE <br /> (signature of owns or building contractor) (date) <br /> ZONING ADMINISTRATOR 1 bw�4 <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 88888 w <br />