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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <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 Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 9 J 1 <br /> regulations of the State of Wisconsin. ,u 7 i w E <br /> 1iJ-i1 _n.w._ � w .� <br /> c <br /> �OWNER 1 Tn E <br /> oT�QY U TELEPHONE� IV�G,__v 7r5 as� - 3 9�0 >-� <br /> ADDRESS K'r 1�� . /�J Q >\ �4 Ir W i S 0 '-f P\ <br /> EMERGENCY/FIRE NUMBER ROAD NAME ^ I Kcr4L_ <br /> LEGAL DESCRIPTION see tax receipt) q" _ V <br /> CONTRACTOR A, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONS p <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: r 1 C- 1�Q h Qi Cl Y Q1 P o <br /> G � � /c:6>����-tom o^ _ <br /> (Home/Cabin;Commercial Business Bedroom;Deck;etc.) z <br /> 'o <br /> P v r <br /> P <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 (VV),septic tank(ST),and drainfield (DF). <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. <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. c a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o to <br /> c <br /> PLOT PLAN o n <br /> O <br /> M LE <br /> C . <br /> � 1 <br /> - _ s <br /> � m <br /> I • I <br /> & T <br /> m <br /> z <br /> t-, <br /> f <br /> � mrnvm� aap � <br /> CONDITIONS OF PERMIT: o 13. [ Q Ce 0 Z ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. z o o i ` s'o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c E ' ' T�2 lei 9 <br /> }j <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 2 -',i m <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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation <br /> I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8: 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 /> 8-cee5 to the described premises at any reasonable time for the purpose of inspection. i u Y <br /> € : 38x . <br /> m V A P <br /> SIGN HERE <br /> F <br /> ignatloro f owner ox buNding contra-or) '- - — (date) a E <br /> i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED T m <br /> 88888888ai <br />