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v <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 0 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. 17e O, ,6V 30? / Q S•-� LJZf�j�/3 w <br /> OWNERj�� C�J� :,1 TELEPHONELj� - S a F <br /> m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' V <br /> LEGAL DESCRIPTION (see tax receipt) SYy SCJ `7`�• �G ,3� ��900 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: / 7N -r <br /> 0 <br /> (Home/Cabin;Commercia dsiness;Bedroom;Deck;etc.) Z <br /> P 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 well (W),septic tank (ST), and drainfteld (DF). I o <br /> 3. Show dimensions in feet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -4 <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a N <br /> PLOT PLAN o <br /> M 0 <br /> y <br /> 14 <br /> IN � <br /> ,V� <br /> m <br /> >abo 1 <br /> 4 v �_ <br /> 5 <br /> ^ I 0-� furrD ➢ p p <br /> m a o. o �my <br /> CONDITIONS OF PERMIT: o Z ' Z a o m' 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHI 60 DAYS OF PERMIT ISSUANCE. o 301 <br /> r� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'm <br /> g ; <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- t m o ` C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- ' c f ` y!o- ' S <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- G <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 u 8 <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• w <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have, <br /> access to the above described premises at any reasonable time for the purpose of inspection. t n Q <br /> tet : 3 <br /> 41 9 A A d . <br /> �cp �,(� J � '•1 ,Y <br /> SIGN HERE �A` �" "— �; <br /> (sign acro of owner ding contractor) ' t 7 f) ,, -- p ; <br /> ZONING ADMINISTRATOR ��' 8 i s- <br /> ! N�' T <br /> TOWNSHIP P RMITS MAY BE REQUIRED f� j NOV I L I9 �'�'pW ern' o o m <br /> U 8888888ai <br />