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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 2 <br /> o m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <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. <br /> N <br /> C <br /> a O <br /> OWNER ''1 � t I I�_ -y-J� v TELEPHONE m 1D <br /> ADDRESS Jay75S IOoJq.,cite 5�,r�ner k.y 54 got -t <br /> EMERGENCY/FIRE NUMBER y 755 ROAD NAME LK <br /> LEGAL DESCRIPTION (see tax receipt) LU+ 7 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION X o <br /> n C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 2 � <br /> o < <br /> 0 <br /> STRUCTUREIADDITION USE: bei-K O( p101 -ro ;--�C41., 71 <br /> fc laf�lk o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; .) Z <br /> 0 0 <br /> 0 <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 thefollowing:(a) building to all lot lines,(b)buildingto 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 <br /> dated by the owner. O o <br /> NOTE-. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In 3 y <br /> PLOT PLAN ` o i <br /> 31 roo <br /> o <br /> 13 <br /> Y i to , <br /> w � m d <br /> C> rn <br /> � o <br /> N <br /> O / <br /> b <br /> I N Oe Iu d <br /> •favi �:rcti� ��_.-�--'-i _ �Lt1 (.��Guy"- !" <br /> 4Ake- -[n, z <br /> ' z <br /> 15 J� , <br /> D f nN m r- ➢ D O n l <br /> 2 o c m m 0 0. F m <br /> - <br /> I CONDITIONS OF PERMIT. l "" -�.. � 1, � m < C m o o h <br /> _.t _� �-� ,y. G. N 'z N O O t0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSU�NCE. o FD' <br /> a S T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 11 = N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED." 'm g C_ <br /> c <br /> i $ ` i m D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o O : 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 $ m <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^rged with administering county ordinances or other authorized person to have O . p <br /> access to the above described premises an reasonable time for the purpose of inspection. 3 B <br /> m 3 N <br /> SIGN HERE }/�(4 At <br /> w a : <br /> (signs ner or buil rector) (date) E I <br /> o : <br /> ZONING ADMINISTRATOR <br /> N N N - N� T <br /> TOWNP PERMITS MAY BE REOUIRED N N N O N O O m <br /> 889898 rn <br />