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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. , r� <br /> regulations of the State of Wisconsin. y U <br /> w � <br /> ' I c <br /> OWNER �•�n ,e_ /�. /c�, 2r TELEPHONE E, z_Mgg3_ Z y f '` O <br /> ADDRESS SSS /` C �C+ / m I �/ <br /> EMERGENCY/FIRE NUMBER /`/ ROAD NAME t^ nO 4:�_#-k <br /> :nC hV <br /> LEGAL DESCRIPTION (see tett receipt) /0 f C S '7 r <br /> CONTRACTOR lei-1-5 Z1 3/ 1 3 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE IJ ADDITION o <br /> n G) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> r <br /> STRUCTURE/ADDITION USE: <br /> H74r4 0 ° <br /> v <br /> (Home/Cabin;&mmercial Business;Bedroom;Deck;etc.) a o <br /> 0 0 <br /> m <br /> rn <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). g <br /> 3. Show dimensions in feet of thefollowing:(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. Q <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on N <br /> PLOT PLAN ,,SCP tbdOle,r. #qb A o a <br /> C <br /> 0 <br /> Cen- 4e <br /> iII <br /> r <br /> 304re� ty1.•fofwv.� ) <br /> — N <br /> �}J 0 <br /> N <br /> 7, z y ,y <br /> y- 0 <br /> � y <br /> R N <br /> v Z <br /> � vu � --- � <br /> f <br /> /et <br /> m a m a= M <br /> D s{ w <br /> CO DITIONS OF PERMIT: ^ Z 8 ro i <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. o f 0 �•Z 1 <br /> 2. REMOVAL OR eUT'RNG OF.TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ++ �� ` =m>�i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. W N o: m <br /> o ;a. ( Fr ; E O <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- ro 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 <br /> further accept all liability which may be a result of the County of Burnett relying on this informati N <br /> plication. I spree to permit county officials charged with administering county ordinances or oth ttfor?z00"�fer h to id- <br /> have E a <br /> access to the above described premises at any reasonable time for the purpose of inspection. ll o m <br /> I im m m e 0 <br /> SIGN HERE <br /> e+: <br /> (sip ur of ownI building contractor) (date) <br /> ZONING ADMINISTRATOR x <br /> 8 x <br /> es�MJMN e! Zt <br /> TOWNSHIP PERMITS MAY BE REQUIRED O Nn N oN % MM <br /> ea <br /> 0 <br />