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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o �o <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> v o <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 m IC <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. o <br /> N m <br /> m � <br /> c O <br /> / m <br /> OWNER TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER //�j ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> //.rilir/ .s;a s �!liif,PyiE-�f�•/,arf� L6�/„� !�_T, <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION �� p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: �'<'/jVE'F—it-i-�(��(c'G/7 �</Ff7 Fx�S'�sf/.y Fri o ° <br /> (Home/Cabin;CXmercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <br /> m <br /> a <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)building to center line of road,(c)building -q <br /> measurement to the ordinary high water mark of lake,stream,or river. C <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a rn <br /> PLOT PLAN p o n <br /> `414 ��`A7 7; N: <br /> / s <br /> s sr*ez- <br /> t .� �o u,rl 3T,v�To r, m �s <br /> i <br /> -/ <br /> ENc loses o��o�cz`o p� o 1j0!/.4E fjC'&Z."/Av 4exll _ <br /> 7' �oE,P/��i7r Z`o 7' ll�v )I' oc+LsR ZX <br /> rT0 Ali <br /> m <br /> O U <br /> s2. N <br /> �/� - <br /> See Permif �s�3 �r `.Z ' <br /> �/or PlaAJ <br /> 7J Nrnv (nr DDp 17 <br /> m o c m m o p <br /> CONDITIONS OF PERMIT: H a <br /> <. m 2 o �0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 T'Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ »t M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V : 602 <br /> ga $ <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. e* m .n O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this mfor- N <br /> mation 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 O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ <br /> m 3 s : <br /> SIGN HERE <br /> m : : <br /> N 1 <br /> (si Stun of owner Ilding contractor) (date) � s <br /> o : <br /> ZONING MINISTRATOR 8 <br /> E (w E <br /> TOWNSHIP P MITS MAY BE REQUIRED ��u o a o o S' m <br /> 88888888 vi <br />