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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminiptrator m o 0 <br /> IE <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and � <br /> located as shown herein. The undersigned agrees that all work shall be clone in accordance with the requiremer Is of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and w m O\ <br /> regulations of the State of Wisconsin. m <br /> I ftK . <br /> II m O <br /> OWNER �AUl K . .JO��F�Jso� TELEPHONE (�(Z 88 <br /> I- <br /> ^ 1 <br /> ADDRESS 310 z.8 A,`1 p-2 A\ff- a 0VIV <br /> EMERGENCY/FIRE NUMBER ROAD NAME ttJ A UQCtjF. Rp, <br /> LEGAL DESCRIPTION (see tax receipt) I- <br /> S V. - II NW SX '-' -1 <br /> CONTRACTOR r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> STRUCTURE/ADDITION USE: St'1E17 STO � <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) 0 0 <br /> 0 <br /> } <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 No h (N). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). I ° <br /> 3. Show dimensions in feet of thefollowing:(a) bulldingto 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 O <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A 3 m <br /> 1A Z c <br /> o n <br /> PLOT PLAN �� �l<� <br /> v <br /> 315' <br /> �qi I <br /> 10 <br /> 50 <br /> V � IBJ N e <br /> � "�' <br /> 8 <br /> IT- <br /> M <br /> nm .D ����nrDDOy <br /> - -- — - - -- Ra £mm <br /> CONDITIONS OF PERMIT: . <br /> e E _' .z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM SSUANCE. �N. XI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI E. - <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Wp( Z' O <br /> i <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- MON , <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy fall informs- " o+ �, . C <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize t list this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to ise e a permit. I $� 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am provid ng in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized P Irson to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. T E <br /> m o <br /> SIGN HERE - M <br /> (sign no <br /> or it g tractor) I --- (date <br /> E 8 i <br /> ZONING ADMINISTRATOR <br /> _ 2 <br /> TOWNSHIP PERMITS MAY BE REQUIRE m4�8 N N n <br /> I I egslygg�,88 ng <br /> �- <br /> I _ <br />