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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o / o <br /> APPLICATION FOR — LAND USE — PERMITS >E <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m ° CIQ <br /> 9 by 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 o c .i <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. o S. <br /> w m <br /> w � <br /> / c <br /> OWNER �rl/')`�d S�� �' /yf �/v <br /> TELEPHONE , t lY �so O <br /> Y <br /> ADDRESS IS / T� xQ r/ <br /> m <br /> // r Q <br /> EMERGENCY/FIRE NUMBER ROAD NAMEy-B��� /1y /� _-/ a <br /> LEGAL DESCRIPTION (see tax receipt) // -'' /j /yy�-"' <br /> CONTRACTOR C % <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE, ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> 71-TRI Iln� y r <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> r <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). 5 <br /> 3. Show dimensions in feet ofthefollowing:(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. 0 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 3 <br /> y <br /> PLOT PLAN z Q <br /> q9" <br /> i ' SS <br /> v J� <br /> � 1 <br /> /�vv s4 <br /> L� 0 <br /> O <br /> o m <br /> a <br /> D <br /> CONDI IONS OF PERMIT: - �f -` r a D E m M <br /> < -i ZC�' gr2 C <br /> 1. DRIV AY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUAN o I. - SQ � <br /> 2. REM OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : <br /> 3. NO RADIN R SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. In' L7 T <br /> I <br /> t l E ; O <br /> I declare that this applicati including any accompanying schedule)has been examined by me and to the best of my knowl- i O i . <br /> �i <br /> edge a belief it is true,carr nd complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : "m" R�1 <br /> tion conte in this aDPlication(i uding any accompanying schedule)and I further declare that I recognize that thin infor- is <br /> motion I amp (ding will be relied u by the County of Burnett Wisconsin in determining whether to issue a permit. I gr$ 8 <br /> further accept all I lily which may be a r It of the County of Burnett relying on this information I am providing in this ap- <br /> plication.Iagree to pe county officials chs ith administering county ordinances or other authorized person to have q' <br /> access to the above descri remises at any reason 'me for the purpose of Inspection. R <br /> SIGN HERE <br /> « [ <br /> (signature of owner or buil g eo tractor) / (date) ? ra+ <br /> ZONING ADMINISTRATOR � / 8 <br /> TOWNSHIP PERMITS MAY BE REQUIREDo N N m <br /> 8888 8818 vi <br />