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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> n <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m C <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> n <br /> regulations of the State of Wisconsiprt <br /> m o <br /> -70y6 :E <br /> O <br /> {� <br /> OWNER Gr.0 I �. Uti.. TELEPHONE G�� —,a _ Oa E <br /> ADDRESS J �� �l ✓�. A) L^, 7JI�) ✓�� �� C—u� y� 7 <br /> EMERGENCY/FIRE NUMBER A �O�` ROAD NAME / <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Lo 11., i kI c"04Awe= <br /> CONTRACTOR <br /> 'Set p" <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Comm cial Business, edroom;Deck;etc.) y <br /> /fr`i l 0 90 S <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 the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building 1A <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 X <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 rn <br /> PLOT PLAN o 0 <br /> m y <br /> (� coo <br /> SE'> I l C< �v d c� ✓ � <br /> Q, <br /> O <br /> Jo <br /> 0 1 <br /> O W <br /> n <br /> 76 <br /> N <br /> �. <br /> �j(,r�� sur �� t'err�✓� r i <br /> S-�-prnr�¢/�t,c,•�ECho�,�e `1-� bC 4,� /2c�s I -�[ <br /> D (n fn V (nrDDp � <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5. T i? T o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : _ » m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. OC <br /> 7�8 : aS E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 4_110 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 informa- --L <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ro 0 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1CJf1 : 8 W 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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any re enable time for the purpose of inspection. m 8 <br /> m 3 <br /> SIGN HERE <br /> (at to is of owner r uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE MITS MAY BE REQUIRED oN N o fL o m <br /> 8 8 so <br /> ZIP <br />