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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrators m{J o (j! o <br /> APPLICATION FOR — LAND USE — PERMITS 3 = <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. - <br /> N m <br /> /� L�j <br /> OWNER �•r nhF'Y� TELEPHONE �� � - � � Z- D a pp f �� <br /> r74 O O m <br /> m_ <br /> ADDRESS 3� 3 WeL 60 %) . . S <br /> EMERGENCY/FIRE NUMBER ROAD NAME Pu Y K S O \ <br /> S' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> W / 0 r <br /> STRUCTURE/ADDITION USE: ��or,tL 9e d t,r u f K Sip(,� / g 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> v <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). <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. <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. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In 3 y <br /> PLOT PLAN <br /> ry <br /> m W o <br /> v ; C o^ <br /> 01 <br /> r <br /> ci 25, <br /> ur <br /> "� <br /> 2,- S ° <br /> _ <br /> CIO, <br /> o � Z <br /> tX <br /> `tic, <br /> M 0C 000ao <br /> 0' D d . D E m a = a <br /> CONDITIONS OF PERMIT: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY 4IDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a E 5" : 0 'z 'f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - »t m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> g 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 I e L� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa cw m to 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ; $ m $ <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 ' O fn p <br /> access to the above described premises at any reasonable time for the purpose of inspection. . m 8 R <br /> M N A m E <br /> m $N N <br /> SIGN HERE i w i n i <br /> (si nature of owner or buil g o r (tlat o x <br /> ZONING ADMINISTRATOR $ <br /> TOWNSHI PERMITS MAY BE REQUIRED <br /> V NpNiO.'o N oo 9 m m <br /> $ $ $ $ $ $ $ $ um, <br />