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i • <br /> Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator N o <br /> APPLICATION FOR — LAND USE — PERMITS s. . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 v 0() <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 o <br /> regulations of the State of Wisconsin. w m <br /> c '? <br /> OWNER `I7 p J i [� SE R o►�t E. TELEPHONE o <br /> V n { I r' m_ <br /> ADDRESS 30961 TABDR, Lg - VR y/-}NSU(Z.S/ WI . -�11950 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> `! n O <br /> SANITARY J� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIO 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: S4WI I ( -18 <br /> (Home/Cabin;C martial Business;Bedroom; Deck; c.) Z T <br /> 0 0 <br /> v <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 drainfleld (DF). o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building —C <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1111 o y <br /> PLOT PLAN P �. <br /> I11 o <br /> C <br /> rr 0a f �^ <br /> M <br /> t� <br /> o <br /> O y <br /> m <br /> Z <br /> ( I <br /> IllllyN_) <br /> F <br /> g �'�� � sf m <br /> m $� Ita � g7D <br /> CONDITIONS OF PERMIT: "c' Z c`B ='3 IC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o : �`Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" ` O C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- o f « «$ m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor- ON EB . 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 providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE (slonfilsias of a. buildim-0 inn someru- � <br /> � � .; - ..._ (date) E € <br /> ZONING ADMINISTRATOR nivirf '• g E <br /> TOWNSHIP PERMITS MAY BE REQUIRED! u o R 5 N'S' m <br /> i _ ---- - - �$ 8 8,8 8 8'8 vi <br />