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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator rbm o a <br /> APPLICATION FOR - LAND USE — PERMITS3. — <br /> m O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <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. �, m <br /> C m <br /> (JE! n <br /> OWNER ��VD/� -Z/s!� TELEPHONE 3 75 v OF <br /> ADDRESS �- 7� G'a6 ,C/aiYt� /?/0- <br /> EMERGENCY/FIRE NUMBER ROAD NAME � {/✓/ /. 'O/V �,�1 J 0i'n 1 <br /> LEGAL DESCRIPTION (see tax receipt) —1 <br /> �I,11 <br /> CONTRACTOR 0.1 0 0CONsf s ll� <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGX GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> J — <br /> STRUCTURE/ADDITION USE: HcM rte/ CAB1,A o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 1J <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). <br /> 3. Show dimensions in feet of the following:(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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must 1: signed and 'A <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BLEFORE A PERMIT CAN BE ISSUED. 1I a cn <br /> PL�� N/N�t�OIIA��Sll S 0/ /IY�fS<C� <br /> M a <br /> TIf <br /> •� O <br /> N <br /> 30 <br /> ` N <br /> VX O <br /> J <br /> czq <br /> v <br /> n, <br /> ,til`- z <br /> I <br /> JA,M ;sJlnr fdAO <br /> f <br /> D <br /> 17)1N p g� d a y m <br /> CONDITIONS OF PERMIT: < R.: C�' J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E �Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m M <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «�m>, m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. ig o : O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <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 <br /> 0" 0 : <br /> access to the abo ascribed premises at any reasonable time for the purpose of inspection. �- <br /> v <br /> SIGN HERE <br /> (sl tura of 06ner o but ing r t (d <br /> Y o ; <br /> ZONING ADMINISTRATOR 0 <br /> .L wtn�en en T <br /> TOWN PERMITS MAY BE REOUIRED j 'o N & uN m <br /> LU I <br /> L% 00000 $ o y <br />