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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 51472 Office of Zoning Admini#trator " N a'0 <br /> 5. z< <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descrited and 9 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremery s of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the li nNs and <br /> 0 <br /> regulations of the State of Wisconsin. w w <br /> c m <br /> OWNER TELEPHONE (•• <br /> ADDRESS O / / [v 'r �•�/A/' • �3' /m l/ <br /> EMERGENCY/FIRE NUMBER ROAD NAMEE^ ,E.�i�w ��J pr J <br /> LEGAL DESCRIPTION (see tax receipt) f <br /> �O�a �S o�� t- a���.JS AlJ•eP Jv 57Tvo� <br /> -re..✓NO v h 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY -Z4— _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> _ <br /> w � <br /> 0 <br /> STRUCTURE/ADDITION USE: ©�I ° <br /> v <br /> (Home/Cabin;Commercial Business/Bedroom; Deck;etc.) 0� 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 Nort i (N). �1 <br /> 2. Show the location of the well (VI),septic tank (ST),and dralntield (DF). r� 4 <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. Q <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all,ned and <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. 1A 3 m <br /> Z o <br /> PLOT PLAN ° Z <br /> LA. <br /> C { _ <br /> Y <br /> el qNq <br /> G <br /> ° <br /> O � N <br /> = <br /> _ V <br /> O <br /> 0 � � <br /> w 1 <br /> Z <br /> IS <br /> F <br /> m r�rE)L�1� O y <br /> ff m <br /> 13 <br /> CONDITIONS OF PERMIT: v' 3: I 33 <br /> g g � <br /> �'z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p i ' '• <br /> 33 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONQ SHORELINE. —N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" O p <br /> sl� C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl- f)\t N ? m <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize ih t this Infor• <br /> motion 1 am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issu a permit. I $ $ E <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providir p In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps son to have <br /> access to the above described premise*at any reasonable time for the purpose of inspection. .r ? $5n 60¢ <br /> SIGN HERE ��A-�`� jJ L(�S/fD/f•)'C " ' ' ' ` ? E f <br /> (signature of or r but Ing tr to (data) <br /> i [ <br /> 8 : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED � ) � g g g m <br /> 88 88;88 U) <br /> j'�ci lot i.��P�K/vliT APP ULoc_ S!4 <br />