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Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator w � c c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 0 m <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 <br /> regulations of the State of Wisconsin. H <br /> m � <br /> C <br /> OWNER TELEPHONE -(s. ws� z4g7 a f <br /> rJ ( O p <br /> p m_ <br /> ADDRESS A aS ICS AZ /�'UE 15,51 ✓Af Ug_ cj C 240 m <br /> d� r n <br /> EMERGENCY/FIRE NUMBER q R 83 ROAD NAME71) <br /> LEGAL DESCRIPTION (see tax receipt) U <br /> CONTRACTOR c.J a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> � o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o <br /> / m � <br /> STRUCTURE/ADDITION USE: 'Q6 K O. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Z rop � <br /> I m <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). I o <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto 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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 1I 3 w <br /> c <br /> PLOT PLAN o n <br /> See /r�t� Eb iPLn-►J . m o <br /> cl ' <br /> 1A <br /> M <br /> C) <br /> m <br /> 0 <br /> N <br /> O <br /> b <br /> O � y <br /> Z <br /> S <br /> I <br /> 033 <br /> o c m m o n g m <br /> CONDITIONS OF PERMIT: v < <_ ,z m o 3 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T� ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. l O <br /> g C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o G l m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <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. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N <br /> access to the above describ d premises at any reasonable time for the purpose of inspection. m <br /> m 3 <br /> � m <br /> SIGN HERE <br /> — /0/,a2 ,:;;E- a N <br /> u a <br /> ig f r or b lding contractor) ( ate) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> N c"riioNo ,o � m <br /> 88888888tmp <br />