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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> a <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 511 m <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 <br /> in-2. 70f 9Lfl oq <br /> o <br /> OWNE+l'"""N � -7W—Q96-7`1Cf4)TELEPHONE <br /> ADDRESS <br /> Wl <br /> Fuca OQoi�i r t /ma rTG om i u�(�5 34Z <br /> EMERGENCY/FIRE NUMBER �'1_®� ROAD NAME rJoulsYTHQIX <br /> S\Aj <br /> LEGAL DESCRIPTION (see tax receipt)) �1� 5� <br /> CONTRACTOR IV i <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> u7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o ° <br /> STRUCTURE/ADDITION USE: <br /> (H me/Cabin;Commercial Business; Bedroom; Deck;etc.) o o <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet ofthefollowing:(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. 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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 41 3 N <br /> 71 z <br /> PLOT PLA o o <br /> / M o IT1 <br /> C <br /> M <br /> M <br /> �wvtC1,z, <br /> V s <br /> ( <br /> 0 <br /> o �} <br /> I <br /> o � <br /> z <br /> I <br /> c m a rapy,F m <br /> m <br /> K4 2. <br /> v� 37 <br /> CONDITIONS OF PERMIT: go:: ? C 9 -0, RE <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 f o zmZ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ° I O <br /> �O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- y c G <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- j <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 providing in this ap. I ", <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have mm <br /> access to the above described premises at any reasonable time for the purpose of inspection.P pe m 3 <br /> m A N <br /> SIGN HERE (date) ' <br /> (sl at a of owner uilding contractor) o <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP ERMITS MAY BE REQUIRED o vN N ^n 3 d N <br /> 000g0 $ 086) <br />