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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 0 <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 m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. y m <br /> c <br /> c O <br /> OWNER C) 1GTGis o.✓ TELEPHONE 411S^� o. <br /> o m <br /> m <br /> ADDRESS 7,76YS 01 7--F 4-!i✓' Rd' i�C57—C/ L.✓S .$"�.oY.3 <br /> EMERGENCY/FIRE NUMBER S�/>? ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 3 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> 0 <br /> ��77 �/f �o ' O V <br /> STRUCTURE/ADDITION USE: /'pzl� Rrt,-., 2� <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> D <br /> 3 <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). <br /> 3. Show dimensions in feet of thefollowing:(a)buildingto 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. o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> 11 Z `v <br /> PLOT PLAN 0 <br /> C <br /> 1 <br /> used �,- @ �M �, r� <br /> (,ur <br /> v ° <br /> yoN_ <br /> n <br /> W / Z <br /> L?c , �� ( x <br /> r <br /> Oh/ m nvm n � � <br /> ° oma <br /> o m m <br /> t m, D < m m D <br /> CONDITIONS OF PERMIT: 9 <. 0 ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o < S i 'z a <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. �" � 'm o <br /> $ C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m L� 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 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have u, <br /> access to the above describgd premises at any reasonable time for the purpose of inspection. $ <br /> A <br /> SIGN HERE <br /> (Si ureowner or " g contractor) (date) <br /> o : <br /> ZONING ADMINISTRATOR .�--- <br /> 8 : € <br /> TOWNSHIP PERMITS MAY BE REQUIRED p " <br /> NN Noaooi� m <br /> [�' _ 8888999gum) <br />