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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 0� w O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> c <br /> N <br /> OWNER � ^ TELEPHONE •�- o.r Rv� /meg TS <br /> a m = <br /> n r m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER / W Z-3 ROAD NAME "441 /�a��� j I <br /> (P p q r C J <br /> LEGAL DESCRIPTION (see tax receipt) I G 1-. l• /(- ' LN S U - O(-7 o t> l <br /> CONTRACTOR Ol A. f`Y' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ✓ p t-r�- <br /> n 0 \l <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> a <br /> c r <br /> STRUCTURE/ADDITION USE: #Atl � <br /> (Home/Cabin;Commercial Business;Be room; Deck;etc.) Z <br /> 0 0 <br /> a <br /> m <br /> a <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 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 M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an v v, <br /> c <br /> PLOT PLAN o a <br /> fi1 y <br /> Cr <br /> � b <br /> n <br /> (,5 <br /> f V <br /> Imo' p��K <br /> eN�� orCau <br /> >n <br /> CONDITIONS OF PERMIT: Q p S.: Q' yet' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E L 9'Z <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O 2 rn <br /> 8 l 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 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- - a ro.n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �`: gl p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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 O <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m <br /> m m N <br /> N <br /> SIGN HERE <br /> (sign re t owner or 11 g coE8t1`Wi�JI6E1T_1 <br /> ZONING ADMINISTRATOR TOWNSHIP PERMITS �(� _ $ 3 m <br /> 000 ' off/) <br />