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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872Office of Zoning Administrator /u <br /> ff <br /> — <br /> APPLICATION FOR — LAND USE PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements 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. <br /> OWNER-6(I' &ar-66O TELEPHONE r'7'S•� bS'b— <br /> L `t3Ic1 0 0 'e <br /> ADDRESS rd"i$a i'Af'61.1Yt/ 1V `� Q rq 'S�Qi� 1 �I-dT 1q') e <br /> EMERGENCY/FIRE NUMBER a.cIIR�. ROAD NAME ��� � Roan I� <br /> LEGAL DESCRIPTION (see tax receipt) N..._1T _ ^ 1C�&, 1 -r 4o N3 R lb W <br /> CONTRACTORL'v rl <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE�, ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <_ <br /> 0 <br /> • t— . 3a ' xaa ' 7GyC, N <br /> STRUCTURE/ADDITION USE: 0QnQQR '/� <br /> (I-Mne/CabinktomrAercial BusineQ Bedroom;Deck;etc.) Z a <br /> o <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 drairdield (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. Q <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. it a N <br /> �_ Z v <br /> PLOT PLAN 0 <br /> M o <br /> C <br /> � V <br /> N <br /> o � <br /> E8 abt <br /> tim <br /> �s 8 Et F <br /> 3a' aa, <br /> '65t ( <br /> Fines I <br /> F s= ue <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a �`Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? ^; ; ? m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ': S <br /> edge and belief it Is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- : N In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- R : p <br /> maUon I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ 8 <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 /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN MERE <br /> (silliikr of owner or building Contractor) (date) <br /> ZONING ADMINISTRATOR - �' 8 <br /> TOWNSHIP 0iEZMITS MAY BE REQUIRED r o g g R�.' , ,'I$ m <br /> 8888818,8'8 rmn <br />