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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U0V m ; 0 <br /> APPLICATION FOR — LAND USE — PERMITS s. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o 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. w m <br /> u m <br /> a O <br /> OWNER �.\c,ck Ue \�)Qp HONE <br /> /� �TELEPHONE <br /> ADDRESS �3d C A L.,_�ker <br /> EMERGENCY/FIRE NUMBER3o3O ROAD NAME C-F, t2.cl <br /> LEGAL DESCRIPTION (see tax receipt) CSL �j7 /VC ,r _qO <br /> r � <br /> CONTRACTOR <br /> L <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o � <br /> J C <br /> r <br /> STRUCTURE/ADDITION USE: � g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z a / � <br /> 0 9 V 4 <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 drainflaid (DIF). 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. <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN o to <br /> Z a <br /> PLOT PLAN ° n <br /> C ° on9 <br /> a _ <br /> rn <br /> I <br /> N <br /> O <br /> IrJ <br /> O I <br /> J <br /> O y <br /> N_ <br /> n I � <br /> n1 Z^_ <br /> \ n <br /> is <br /> A 9 a3E m <br /> J. f <br /> c �o g'. g m g° 7g <br /> CONDITIONS OF PERMIT: g,_; - <br /> Q C S ? ac1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f J i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? �,? �y' in <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0"; R <br /> C <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 <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- O: E O <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 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 in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described promises at any reasonable time for the purpose of Inspection. m gppppppq <br /> y <br /> B <br /> w <br /> SIGN HERE `: E <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR" <br /> ww -n <br /> TOWNSHIP <br /> TOWNSHIP PERMITS MAY BE REOUIRED � N�� N!�� m <br /> 8 $ 8 <br /> $,88 y <br />