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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 i <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned here pp °i <br /> 9 to makes application in for dance 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 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n I(� <br /> regulations of the State of Wisconsin. IrNv <br /> N O <br /> OWNER d /j � TELEPHONE n v O <br /> ADDRESS �IJIL� Y/L-LF A59N .�>3 a <br /> EMERGENCY/FIRE NUMBER 53 ROAD NAME '/ �'J�✓�r^ <br /> � <br /> LEGAL DESCRIPTION (see tax receipt) LD%/ C. S y�j. �O`7' /,✓�,L L <br /> CONTRACTOR3 G // —b <br /> "/y Se.✓ Ad/a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDRION,o I <br /> o <br /> SANITARY PRIVYFILLING/GRADINGQo <br /> CAMPING UNIT SUBDIVISION <br /> o < <br /> ,, � J �j�, o 0 <br /> STRUCTURE/ADDITION USE: IJFC A; /�l.Gt-I� /yam " � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o <br /> 2 0 <br /> o c <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 dreinfield (DF), r <br /> 3. Show dimensions in feet ofthefollowin 2 <br /> m <br /> g: 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. _ <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and I <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 <br /> PLOT PLAN 11 Z Q <br /> o n <br /> / m <br /> I <br /> c N <br /> o � <br /> 0 <br /> N l� <br /> O <br /> N_ ~ <br /> A <br /> Z <br /> I <br /> I� <br /> i�c�wrrDiQ. <br /> > <br /> CONDITIONS OF PERMIT —�'� a m 4 m m <br /> c mm. .Z88 -o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m <br /> TING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 2. REMOVAL OR CUT <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N G] i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of in kn - 2- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- N a o <br /> a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- O <br /> mation 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 providing in this dap- o o <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have nHi <br /> access to the above described premises a ny reasonable time for the purpose of inspection. m!" 0 <br /> m0 <br /> oi <br /> SIGN HERE <br /> (sign re f ovine r uilding con tractop '(date) `e <br /> ZONING ADMINISTRATOR <br /> v 'Sd,d. d.6+dt to <br /> TOWNSHIP PERMITS MAY BE REOUI -n n N N N N N N m <br /> - <br /> 000 0000U) <br />