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l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N 'a 1 z <br /> APPLICATION FOR - LAND USE - PERMITS 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes <br /> 9 by application for r Permit for the work described and Q ` <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 3 n <br /> regulations of the State of Wisconsin. o Q <br /> OWNER `�DI,I,(s1u G�tJ l-. I K TELEPHONE (7�S)�j.S(D - 7 /4/ o <br /> n £ <br /> ADDRESS IIJIO --/+ ��'/ I�` �JJm <br /> EMERGENCY/FIRE NUMBER '1 9 �t 'o ROAD NAME I IT-2 I\�IV �U'ao <br /> LEGAL DESCRIPTION (see tax receipt) 9 l F d ek h( 1--0 ,� ✓ +/r-� - <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o < <br /> STRUCTURE/ADDITION USE: ( F — 6>-/yC. ,— o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> 0 <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). 5 <br /> 3. Show dimensions in feet of the following:(a) 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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In 3 N <br /> Z c <br /> PLOT PLAN <br /> 0 <br /> X l5T/Ncz <br /> a � s <br /> o � <br /> 0 <br /> 0 <br /> N � � <br /> O_ <br /> S <br /> 1 <br /> M o c m m F m <br /> 1 <br /> CONDITIONS OF PERMIT: <br /> < m <br /> a m < C o 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o y <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. <br /> d C <br /> 8 : a5-3 <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 informa- yy!! e. j m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <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 Np <br /> access to the above described premises at any reasonable time for the purpose of inspection. n 3 8 9 <br /> V m : <br /> 1 <br /> SIGN HERE <br /> (si atur of own building contractor) (date) 8 <br /> o : <br /> ZONING ADMI TRATOR `� 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED � N N o^rn'o o `d' tTTt <br /> 88888888vi <br />