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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <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 described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m l/" <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. y m <br /> p a m IO <br /> OWNER lV`TLr)fl N . 1 (,(tlU_ <br /> I A41 SU/j TELEPHONE ADDRESS1172 C,.. !J 141iAl o �. <br /> J <br /> ! <br /> EMERGENCY/FIRE NUMBERFS�,S ROAD NAME <br /> 0 ^^ // <br /> LEGAL DESCRIPTION (see tax receipt) 'J <br /> CONTRACTOR _J/A4 A&/�/./CK Cell Sj fZ GL C-T/L'N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE_ X ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> P z�1 S7DPi4G �' 36 r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> o } <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). r <br /> 2. Show the location of the well (yi), septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(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 9 ,F <br /> dated by the owner. 0 o Vit <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 1I v <br /> 11 Z Q <br /> PLOT PLAN 0 n <br /> M 9) o <br /> SEE ArrArC I+Eb a 1 J <br /> 1 <br /> Cd <br /> W <br /> Gn <br /> 0 <br /> J <br /> N <br /> O <br /> J <br /> J <br /> C] y <br /> N <br /> Z <br /> s <br /> U' <br /> 0 -0 <br /> CONDITIONS OF PERMIT: = Z $ 0 ri; r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 :it : : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =ur 1 M <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. to : 62 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs: 1 u m : m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- <br /> is p <br /> Mellon 1 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. I agree to permit county officials charged with administering county ordinances or other authorized person to have m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> r <br /> !0 m <br /> M � O <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) 8 <br /> ZONING ADMI OR <br /> NN W N N N N T <br /> TOWNSHIP PERMITS MAY BE REDUIRED . N N U U N m <br /> 0 0 0 0 $ 'o 0 o <br /> Off) <br />