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O)l (Z"T, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator dm a o <br /> APPLICATION FOR — LAND USE — PERMITS 3 –` <br /> d 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 0 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. m <br /> 7a7- i �-7 <br /> OWNERTELEPHONES 1 --, 3 � o £O <br /> 7 � 9 - a7� <br /> ! <br /> ADDRESS So r!p, j` S Ave S, ro pJS YYt h SSyI7 0 J <br /> EMERGENCY/FIRE NUMBER 6S0�7 ROAD NAME <br /> w � 1 <br /> LEGAL DESCRIPTION (see tax receipt) 5E'j IN <br /> CONTRACTOR <br /> TY/PES S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> / <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> N <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v � <br /> 0 0 _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> w ? Y <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. 0 <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. -H a m <br /> PLOT PLAN ZQ <br /> o a I ^ <br /> fn o rn <br /> M C? <br /> o � <br /> N <br /> 0 <br /> J <br /> N <br /> o U A/ <br /> J (\ <br /> m <br /> Q y <br /> H <br /> V' <br /> n <br /> F <br /> m �c gip, 50 a:Em <br /> g'� ii <br /> m � afir 0 r = <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. om - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a: ' T-,-ce r a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. -lt 'n m0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «.m a m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that 1 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 0`$ 0 . <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 <br /> 0, <br /> o E <br /> access to the ve described premises at any reasonable time for the purpose of inspection. T Boo <br /> a a A m <br /> SIGNHERE_ `-� `x IQ.Y1' 9-7-9 <br /> � - <br /> (signature of own4Y or building contractor) (date) - <br /> Pi <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N u, Yn N m <br /> - <br /> m <br /> 000 000 f/1 <br />