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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 m - o <br /> APPLICATION FOR - LAND USE - PERMITS C <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown therein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> 0 <br /> regulations of the State of Wisconsin. m <br /> 7 T g <br /> OWNER f.^1�Q.,�A-�A 't' ,,O t C7 VYQ\S�y\2.r-TELEPHONE "��cj _a� �6 -aa,r"{ O o �1 <br /> ADDRESS `� �-� �` -I O �Poo� e � ��\ SH eo I <br /> EMERGENCY/FIRE NUMBER ROAD NAME I \ --` c) <br /> LEGAL DESCRIPTION (see tax receipt) g 310 t 3q ty \ �_ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ✓ o <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION t ° <br /> o <br /> � o <br /> STRUCTUREJADDITION USE: �t <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o o <br /> m <br /> 3 <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 (N),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 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ON VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o m <br /> 11 z <br /> PLOT PLAN <br /> 1�/J,/U^1 m <br /> t ru , <br /> ( m <br /> ,\ C y <br /> f' <br /> o r. <br /> m <br /> � p y <br /> w <br /> z <br /> 1 a <br /> g' <br /> P �I + <br /> 1 t � <br /> r <br /> Do� <br /> - 0 <br /> m <br /> a. <br /> . .. . . - < 2. i Za 00 .012 <br /> CONDITIONS OF PERMIT m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ - : : ?!� <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. AS E ; E m <br /> 8 <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- ? S i o, <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- §m . m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 2'i u p <br /> motion 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m oQE i <br /> A m <br /> A : <br /> SIGN HEREC iT <br /> ��" 8nor ouildinq (date) [ 8 ?ZONING ADMINISTRATORrnalloomNSHIP PERMITS MAY BE REQUIRED 8888888 o P 3 N <br />