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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 1 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. 0 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. rn m <br /> ^ m <br /> OWNER c TELEPHONEvGK� -zy 7-- n £O <br /> ADDRESS a2�I f <br /> EMERGENCY/FIRE NUMBER 2 3 Ca ki <br /> - ROAD NAME <br /> Hl <br /> LEGAL DESCRIPTION (see tax receipt) / L PC -o- 38H i 0004) 3 <br /> CONTRACTOR V � I L Goy/ IOT- c �J <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE _ ADDITION <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING_ CAMPING UNIT SUBDIVISION o 0 <br /> u �/ m r <br /> STRUCTURE/ADDITION USE: 1 C o o <br /> (Home/Ca i600ommercial Business;Bedroom;Deck;etc.) Z o <br /> o a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <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 thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building .� <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 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCIkTIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> 11 Z `o <br /> PLOT <br /> _ELAN <br /> o _. <br /> o <br /> l,A�CA�Sht�� <br /> _I s <br /> d - �' j �. <br /> 3 o0 <br /> N m <br /> )� * 0 y <br /> .ni <br /> S ' Z <br /> m. g� if a m <br /> p m9 <br /> CONDITIONS OF PERMIT: < g' '2 C�' g�F. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 0 `2 <br /> 2. REMOVAL OR CUTTING CF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o' G) o m <br /> .8 i 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- E : r m w m <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> matlon 1 am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ^c E $ <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. id, <br /> plication.I agree to permit cour y officials charged with administering county ordinances or other authorized person to havew N c <br /> access to the above described premises at any reasonable time for the purpose of inspection. n <br /> SIGN HERE ) J / <br /> [ a: N <br /> (si n tur of owner or contractor) I'' ,- -- Mstel� <br /> g <br /> ZONING ADMINIST TOR K X x <br /> j'\ �NN NMnMM �t <br /> TOWNSHIP PERMIT AY BE REQUIRED jl "io u, 9, u,I � ;9m <br /> $ 88$ 8 99y <br /> 1 <br />