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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn m <br /> ,APPLICATION FOR — LAND USE — PERMITS _ f °_ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m C <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. 3 n <br /> v <br /> I <br /> OWNER m `.JV+VV "'.17 .1_ J <br /> WWW TTC i(�� rn•(� TELEPHONE n a <br /> ADDRESS IACR lA YS( u L�. n� n r m J <br /> EMERGENCY/FIRE NUMBER ROAD NAME / D 1, — <br /> C1 (�a I _ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 4 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT ^ O , J <br /> SUBDIVISION - o -� <br /> o < <br /> J <br /> STRUCTURE/ADDITION USE: cdn1+ay14 r- <br /> o <br /> (Home/Cabin, Comm ciai eusme4s; Bedroom;Deck;etca.) v <br /> Z o �J <br /> o � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I� D <br /> a <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). C9 n <br /> Cn <br /> 2. Show the location of the well (VV),septic tank (ST),and drainfield (DF). � r- <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. L <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. <br /> G c� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o <br /> 3 <br /> PLOT PLAN Z <br /> o a <br /> n < <br /> m o <br /> to I J <br /> � W <br /> ::S?E:� A*�act-)Lod,� <br /> I <br /> a N <br /> 0 <br /> J <br /> N I_ <br /> O <br /> J <br /> O <br /> N � <br /> Z <br /> G <br /> 3 ro ave <br /> nIn <br /> CONDITIONS OF PERMIT: m. <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. LaQ C <br /> 5, 8 N J <br /> m'o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f Jy <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- oo' 2 C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ; c.�.,, <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 a permit. I '$ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I amrovidin b o <br /> 0 0 : <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person tol have ni ` <br /> access to the above described premises at any reasonable time for the purpose of inspection. O u, v <br /> m m : <br /> „ 39 <br /> m m <br /> SIGN HERE Y, m <br /> (signature of owner or building contractor) (date) <br /> ---�- �-^ <br /> ZONING ADMINISTRATOR s <br /> TOWNSHIP PERMITS MAY BE REQUIRED o " N N m <br /> O S S <br /> 0 N <br />