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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c f z <br /> APPLICATION FOR — LAND USE — PERMITS - 3. <br /> N <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> N N <br /> w <br /> OWNER Z J ) ZV/1�,� TELEPHONE �J _�+ tc3_ --716 3 <br /> r�pw' 7 /�Vw / / m � / ` J / o ' <br /> ADDRESS C /lrblf yrs GelO, <br /> EMERGENCY/FIRE NUMBER �t/�� ROAD NAME <br /> p <br /> LEGAL DESCRIPTION (see tax receipt) ,lS�e �„✓� �� L/Q i� <br /> CONTRACTOR i / R/ _/� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION ° <br /> o` <_ <br /> STRUCTURE/ADDITION USE: 15�bY1—'J <br /> (Home/Cabin;Com rcial Business; Be r cm;Deck;etc.) Z <br /> ° ° <br /> 0 <br /> m <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 (1M),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. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 41 <br /> PLOT PLAN o Cr <br /> ae <br /> �'�` 7 m <br /> � C <br /> to <br /> Y751 167 <br /> CD <br /> 1- p'Qo 0 <br /> Q z <br /> 9 -'=C ;I�aFm <br /> N �� 2.a N m XI <br /> CONDITIONS OF PERMIT: m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m c —I <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. 6 2 � Rt <br /> o - <br /> �: o C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- v d'm a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- i 13 o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O o <br /> access to the above described premises at any reasonable time for the purpose of inspec�ttiio'n.. T 3 o x <br /> F CD y A y <br /> - o <br /> SIGN HERE ; i ! � .,, E ' <br /> (signsre o owner orb 'ng contractor) ! - =date) ' E KO) p <br /> o :_ <br /> ZONING ADMINISTRATOR <br /> ( - HHH�wrn fy iM 'n <br /> TOWNSHIP PERMITS MAY BE REOUIRE[t'' 1I j o N m <br /> Lita _ 0000 $ 000N <br /> 0000 <br />