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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work de cribed and Q a ° DQJ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirer nents of the 0 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and tI Is laws and <br /> regulations of the State of Wisconsin. 7 <br /> 0 <br /> w m <br /> OWNER ' OL jo— 1 TELEPHONE 7�S �/�_ O <br /> C l '7 <br /> m '9 <br /> ADDRESSjjqgq:j �` <br /> c <br /> EMERGENCY/FIRE NUMBER ROAD NAME P C% <br /> LEGAL DESCRIPTION (see tax receipt)- �f 3 <br /> J9.19�30 T40 f jog ,. <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_XADDITION <br /> SANITARY PRIVY FILLNG:lGRADING CAMPING UNIT} SUBDIVISION o <br /> o <br /> C-1) <br /> -- <br /> STRUCTUREADDITION USE: (Homeabin <br /> Commercial Business;Be room;Deck;etc.) ^"U z ` <br /> o O <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 N rth (N). <br /> 2. Show the location of the well (W),septic tank (ST),and dreinfield (DF). Cz" <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road, c)bullding <br /> measurement to the ordinary high water mark of lake,stream, or river. C N <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. 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN B ISSUED. 0 c <br /> PLOT PLAN o g <br /> U[ . 1 Za T N_ <br /> r1 1 <br /> C e �of v rn <br /> 0. <br /> 8y� ------� �f -a►'� <br /> T <br /> NIS ` <br /> 9 O,C <br /> 1 Qp o. n <br /> ON a mg�zC8g 333 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e f �� <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. m <br /> e : <br /> 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best Of my knowl- ? 0 : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informa- m" T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B ,`a p <br /> motion 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 providi g in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe on to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN MERE <br /> (sl roow <br /> of n undine contractor) O.;'I (date) I `� <br /> ZONING ADMINISTRATOR MAY 39 <br /> In <br /> II <br /> TOWNSHIP PERMITS MAY BE REQUIRE ------ -- — «««'j«w«`� M <br /> o � � iK �� m <br /> —" <br /> 888 8 8 8 8 8 ai <br />