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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c c <br /> APPLICATION FOR - LAND USE - PERMITS 3- <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri d and v m p <br /> located as shown herein. The undersigned agrees that all work shall be tlone in accortlance with the requiremerof the 3 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the I s and <br /> regulations of the State of Wisconsin. a m <br /> 7^/ m m <br /> OWNER C � ✓ 2(G i o� TELEPHONE -71 -K"— / 2 7 n EO <br /> 111��� l.. a7 v <br /> FF <br /> ADDRESS 3 S-6 L O D P k ie/R' L) e. SI : / m <br /> 1 <br /> EMERGENCY/FIRE NUMBER , ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR S E IL <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG CCESSORY STRUCTURE L" ADDITION p M <br /> 0 Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> STRUCTURE/ADDITION USE: Te aV' X c�61 om <br /> r <br /> o � <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <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 sig ed and <br /> dated by the owner. O c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, on 3 N <br /> an <br /> c <br /> PLOT PLAN 1_AAL 15 o 'n <br /> M o <br /> -77C <br /> gSr a <br /> 1 ? T 32- <br /> cn <br /> Q 0 ""Gt�,�V ` ? <br /> --- t' <br /> � e 1 � <br /> z� Cj <br /> DF Z <br /> m <br /> CONDITIONS OF PERMIT: .2 '$ 30 g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c 'Z : C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - �',--to M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" : ' G) ? m <br /> application(including Yaccompanying 1 Y Y <br /> I declare that this licetion ineludin an schedule has been examined b me and to the best of known- o <br /> edge and belief It is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of at informa. i ro«.? m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that i his infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $13 $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information K am providing i n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized perac n to have <br /> access to the above d ribed premises y reasonable time for the purpose of Inspection. a <br /> m <br /> SIGN HERE <br /> s nature owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N' <br /> TOWNSHIP PERMITS MAY BE REOUIRED o $n, 8 g m <br /> 88888 8Ui <br />