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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ;' 4 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 them ; ^ �- <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. N d <br /> m <br /> OWNER `-y, �X�rn u�P1 TELEPHONE m <br /> ADDRESS `1C//I-�, C�',1�ll..f✓JL j )Y1N 1^� ) m <br /> 01 ZY1 �E� i 1 <br /> 25 <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION,(see tax receipt) <br /> CONTRACTOR .IC <br /> seni t �Q — <br /> TYPE OF PERMIT(S):: DIWWEELLLLIINN,G/BUILDING G GJE/ACCESSORY STRUCTURE ADDITION 0 <br /> \y/ n G) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION /\ o ° <br /> STRUCTURE/ADDITION USE: <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 0 0 <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 (D17. <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building q <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I3 m <br /> 11 Z <br /> PLOT PLAN m n <br /> m ) <br /> c <br /> L}- - 0:7 <br /> C <br /> N <br /> O <br /> J <br /> v � <br /> z <br /> �l <br /> m pcO'' e roro 10 m <br /> c.m c m <br /> CONDITIONS OF PERMIT: v m _.: c <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E <br /> : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^� <br /> 2 E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. -H. o 62 : <br /> o : O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the bast of my knowl- : 5 m C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all intorma d. m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infon <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit, If o� o <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 0" 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> m <br /> N N O : <br /> SIGN HERE d' <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �c�,')IG?3ll <br /> �+NNI.rNNN m <br /> TOWNSHIP PERMITS MAY BE REOUIRED O N u N N U Oul <br /> o 0 oog000m <br />