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Burnett County,7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> m o <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 Ordinar ce, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m <br /> c <br /> r 1tn �7C� n O <br /> LJ <br /> OWNER �frlRL� �( -r TELEPHONE q _ r7(,-1'1 <br /> rl <br /> �7 � ^ p m <br /> ADDRESS _9 K !?7 O- Y13N p <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' <br /> t� <br /> LEGAL DESCRIPTION (seetaxiecei t) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> m o <br /> \ <br /> SANITARY 7//, PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> v <br /> Home/Cabin;Commercial Business; Bedroom: Deck;etc.) o 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 thew II (W),septic tank (ST), and drainfield (DF). 1�� ° <br /> 3. Show dimensions in feet of filefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building pJ 1 <br /> measurement to the ordina high water mark of lake,stream,or river. <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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a rn <br /> �I 2 v <br /> PLOT PLAN () ° n <br /> m o <br /> A1T�ac.r�Ee m <br /> I <br /> 0 <br /> 0 <br /> N _ <br /> O <br /> j <br /> ,O <br /> v � <br /> z <br /> f <br /> O,c W r0 Off.f <br /> n .g�33- 2. 0 r= 9 <br /> m <br /> CONDITIONS OF PERMIT: m m' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p E 0 r' <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =-� : M <br /> :n: 2p : <br /> 3, NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ob B ° D <br /> : EL <br /> I declare that this application(i eluding any accompanying schedule)has been examined by me and to the best of my knowl- ^ N <br /> m B C <br /> O <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ) " m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B O <br /> mation 1 am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $'2 }$ <br /> further accept all liability whic 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 cou ty officials charged with administering county ordinances or other authorized person to have N O o: <br /> access to the above described premises at any reasonable time for the purpose of inspection. - <br /> 1D <br /> m <br /> SIGN HERE <br /> DD _ :o <br /> N: N : <br /> 164i <br /> p : ao <br /> I � 8 : <br /> ZONING ADMINISTRATOR tm [ g ` K <br /> TOWNSHIP PERMITS MAY BE REQUIRE 8 rn <br /> N <br /> $ $ <br /> I � <br /> 0 <br />