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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator in m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS . f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the MM $ , R <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ 0 1 <br /> regulations of the State of Wisconsin. o <br /> m m <br /> n w � <br /> IVc <br /> OWNER <br /> KC� . V a✓� hR�IVV A1� TELEPHONE n £ <br /> d <br /> ADDRESS p a 6, n lg Y1 /_ r) f1 m U— <br /> EMERGENCY/FIRE NUMBER ROAD NAME�a Oft <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O <br /> O I <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° l� <br /> w � <br /> STRUCTURE/ADDITION USE: 1tYY11 S G ON o °. <br /> .. (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z n <br /> o <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). o <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. U separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s gned and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE.,FOIE A PERMIT CAN BE ISSUED. 11 o m <br /> PLOT PLAN /J L M►t'ty o 0 1 <br /> P o �Lfi�d M ) <br /> PC( <br /> C' � e l tj ph <br /> V ) <br /> � fip 1 <br /> N <br /> s6b P/t r <br /> 6 4 00. -� 2µ 1J, <br /> p�efa-11 40� z �'X �`� ?i <br /> I✓ nor (v/ <br /> >5r 4r35ftA-. sof/c <br /> Lam, br)6 :r'0rn <br /> F� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. IJ`� �' I m <br /> 10 <br /> PD (including Yaccompanying Y Y J � <br /> I declare that this application meludin an schedule)has been examined D me and to the best o m know]- <br /> edge <br /> (" o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- "'m'" M <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize tit this infor B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ape ' <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe on to have o p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 1 3 <br /> m ' i v fu ; <br /> SIGN HERE �i%r- ✓��1' 2- — C .. w <br /> h N: <br /> (signature of ow f or building contractor) (date) r� <br /> ZONING ADMINISTRATOR E 8 <br /> NNN N+MM N+N II <br /> TOWNSHIP PERMITS MAY BE REQUIRED o Ni S(i( )`n' a'S m <br /> 888 $$$ $8 vi <br />