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Burnett County 7410 Co. Id. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn 's + ' Z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby by makes application for aPermit for the work described and c ° <br /> located as shown herein. The dereigned agrees that all work shall t>a done in accordance with the requirements of the m m J <br /> Burnett County Land Use Ordin ince,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. = o <br /> m <br /> r_ <br /> L <br /> N W 93� o <br /> NER TELEPHON n <br /> o � <br /> ADDRESS . O1 <br /> EMERGENCY/FIRE NUMBERS <br /> S SS A ROAD NAME &2, � <br /> LEGAL DESCRIPTION (see tax receipt) °7A/ .V I V 2 IfI✓✓� P,4,E' "T- * y t <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/1 WILDING GARAG CCES Y STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT `= O <br /> SUBDIVISION ° <br /> o` < <br /> STRUCTURE/ADDITION USE: <br /> o ° <br /> (Horn abin;Commercial Business;Bedroom;Deck;etc.) Z '9 <br /> o ° <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 woql (W),septic tank (ST), and drainfield (DF). 6 <br /> 3. Show dimensions in feet oft s following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordina high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submited by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. n <br /> NOTE: BUILDING/STRUCTURE LOC TIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a <br /> PLOT PLAN 11 Z v <br /> C \KW > <br /> 1.00 <br /> 1 <br /> e 1 / <br /> ty PT 1 <br /> 0 7 <br /> MB <br /> � I - <br /> . <br /> NEASE, s�f--E /4Ti+Tdi6d s/ir-1T 742 <br /> T25 t ' �-)r-t 0&k#n GA�-- Lde M T C- >a a <br /> CONDITIONS OF PERMIT: m, a i£v5 ay Q'�- m <br /> D < N•' `� C O �fp <br /> 1. DRIVEWAY MUST MEET DR SWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o �' 1 8 -•1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. *�*� <br /> v : <br /> 3. NO GRADING OR SHORE D ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMrrrED. ut : E O a: M in <br /> I declare that this application(Incuding any accompanying schedule)has been examined by me and to the best of my knowl- ° : [? O <br /> ` C <br /> edge and belief it is true,correct nd complete.I acknowledge that I am responsible for the detail and accuracy of all informa. �` i «m yy`• <br /> tion contained in Chia application(including any accompanying schedule)and I further declare that I recognize that this Infor• �{ E $ a 5 M <br /> mation I am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> 13 <br /> further accept all liability which ay be a result of the County of Bumett relying on this information I am providing In this t, '• <br /> plication.I agree to permit count officials charged with administering county ordinances or other authorized <br /> access to the above described p miles at any reasonable time for the u Person to have ro <br /> purpose of inspection. Pp' t�tff ;w <br /> m05 :o <br /> SIGN HERE �f - - 7 fj ; `.,� <br /> sig tui f owner or b b contractor) I ' ';.. • N' <br /> ZONING ADMINISTRAT - -t- <br /> TOWNSHIP PERMITS MAY BE REQUIRED u 1994m <br /> 0 <br />