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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m i / o <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations the State of Wisconsin. <br /> w m <br /> m <br /> ///""" n O <br /> OWNER ' I�ad ' 1b�lnor TELEPHONE 399- �3(/� E <br /> wad Vl/C1V11 f(' 1 0 ' <br /> ADDRESS -7n , <br /> -7n , webc_'k� V ). hygeq s m� <br /> EMERGENCY/FIRE NUMBER r� „ ROAD NAME 1 " <br /> LEGAL DESCRIPTION (see tax receipt) —� <br /> CONTRACTORIF���� <br /> TYPE OF PERMIT(S): DWELLINGI/BUILDING GARAGE/ACLE AISSORY STRUCTURE ADDITION p <br /> no <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> 0 <br /> m � <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> a <br /> m <br /> 3 <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). o <br /> 3. Show dimensions in feet of thefollowing:(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. 0 <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o ur <br /> c <br /> PLOT PLAN n o 'n <br /> M o <br /> h <br /> 4*-a /CGI S� C I t <br /> M t\ <br /> �� � e <br /> q P <br /> d)p <br /> y <br /> m <br /> o` <br /> O 1,1^IV1_I <br /> O � <br /> rn <br /> n <br /> Z <br /> x <br /> NN v (nr DDO V <br /> o o. F In <br /> 'am o- m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z tD o �z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'm00 <br /> I C <br /> c <br /> a � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- '" w m w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- . . . N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ '? g <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing int his ap- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have u, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 8 `k <br /> m 3 x : <br /> ° A <br /> N N 8 <br /> SIGN HERE fn a <br /> (signature of owner or building co <br /> ntr <br /> ac <br /> "tor) (date) o x. <br /> ZONING ADMINISTRATOR _I he.` 1 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 <br /> 61N N -• N -� -� <br /> 0 <br /> NOS O� OOi . m <br /> 8g88gggglmn <br />