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Burnt County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -a o c <br /> APPLICATION FOR — LAND USE — PERMITS _ <br /> s ; <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 requireme its of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. w m <br /> w m <br /> OWNER TELEPHONE <br /> Lov%jl 753 I <br /> o <br /> m_ m <br /> ADDRESS SS.zU I I z C (U IM w(,, S S'yy IF <br /> EMERGENCY/FIRE NUMBER 3S'3 ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> L. <br /> CONTRACTOR <br /> wr C `, r' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 7 ADDITION p <br /> r O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ' 1 <br /> o + <br /> r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> 0 v � <br /> m <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). I o <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. O o <br /> NOTE', BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. III v m <br /> c <br /> PLOT PLAN Z <br /> ./ ,'/I r <br /> s �iF 14ILI, ,L-a �tyi.,.j-� III o/ a <br /> 0 <br /> n//�• !JI ,(,, n �, <br /> ` oIuC�6�0'.ry 6� PPihl'�c� <br /> O I <br /> r- Z <br /> m c c M D O y <br /> gCONDITIONS OF PERMIT: <br /> < Z g 4 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e � Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 5 : i71 <br /> 71 <br /> O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Us �` ` t5 E m <br /> J pg <br /> i Lr : [ I, <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of a I informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue i permit. I -i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials clilarged with administering county ordinances or other authorized pe n to have ` <br /> access to the above d cribed premiss easonable time for the purpose of inspection. <br /> SIGN HERE 'Z CIS .J N <br /> gnat o o r or building contractor) i- N <br /> ZONING ADMINISTRATOR c ''-^ "` $ E <br /> MMN+MNN+ �t <br /> TOWNSHIP PERMITS MAY BE REQUIRED 2 e io + N N (m N995 ii . N <br /> O NN Oe1Ntm0 m <br /> I''. i.1 ',, � ', 88888888fmi� <br />