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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o oz <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned her makes 4 <br /> located as shown herein The undersigned 1dB131g eby application for r Permit for the work described and v _ <br /> ,S Sanitation <br /> C that all work shall be done in accordance with the requirements of the T <br /> Burnett County Land Use Ordinance,Senkation Cede,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> OWNER /3 // % �-y TELEPHONE `/,. 0��c C a E <br /> h wrri J 0 9 .S .S.j p = <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ;�I'r SI 15 /77A/ <br /> ] � 4 r �NA-M�E7. <br /> 2 C' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR M 1 •t <br /> 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE T ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION n o <br /> rr o 0 <br /> STRUCTURE/ADDITION USE: _ \foo <br /> ru�.a S lie . <br /> (Home/Cabin;Commerci usirless;Bedroom; Deck;etc.) Z v <br /> 0 0 <br /> 0 <br /> m <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 dralnfleld (DF). 5 <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 a <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED on a N <br /> PLOT PLAN z co <br /> no n <br /> o <br /> __]rCP C I = <br /> r <br /> i <br /> r <br /> 1 0 <br /> _ <br /> N <br /> (/1 <br /> 0 <br /> _ <br /> a <br /> v � � <br /> N <br /> / Z <br /> � & m <br /> CONDITIONS OF PERMIT: v Z;: S C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 'o' • ? �Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i O <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the beat of my knowl• E <br /> edge and belief it Is true,correct and Complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor. 25 25 E m m <br /> motion I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 $ 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.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. <br /> SIGN HERE <br /> (slgu,ryof owner or I Ing contractor) (dNe) «E € <br /> ZONING ADMINISTRATOR <br /> i 8 i i i <br /> TOWNSHIP PERMITS MAY BE REQUIRED �Q'o g 'iN g m <br /> I�88888 8I8 rn <br />