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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N v - z <br /> f <br /> APPLICATION FOR — LAND USE — PERMITS _ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and $ x� <br /> regulations of the State of Wisconsin. <br /> OWNER TELEPHONE 5 O52 o m ? <br /> ADDRESS U . IF)01L '-, S z�� S SLQ�r1,lt <br /> EMERGENCY/FIRE NUMBER G QY64 EZ 5 M --5,A/6� � <br /> C_ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING_ CAMPING UNIT# X SUBDIVISION o o �. <br /> 0 <br /> STRUCTURE/ADDITION USE: i(-l(- <br /> (Home/Cabin; <br /> ((Home/Cabin;Commercial B siness; Bedroom;Deck;etc.) <br /> Z 'o <br /> 0 <br /> m --G <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). L <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF), a <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. 0 ,�# <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and � <br /> dated by the owner. O O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFOo <br /> RE A PERMIT CAN BE UED. o <br /> w <br /> PLOT PLAN z ` <br /> o n <br /> �tiGLo Ino 0 <br /> c <br /> o <br /> _ me <br /> ra <br /> m <br /> 0 <br /> n 0 <br /> O -v <br /> w <br /> J <br /> I <br /> m ����mDnOM <br /> m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a zi Z —42. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rn ': y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <7 i In <br /> poQ Lr O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am res y <br /> 9 responsible for the detail and accuracy of all i forma- �"m "' 33 <br /> m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that thisinfor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I '��'• '• i g'Q $ i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in his ep• <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person o have O <br /> access to the above described premises at any reasonable ti a forpe urpoae of inspection. <br /> SIGN HERE 2l - <br /> (signs owner -- <br /> r g ntraeto <br /> rl I t idaeelJ€ € <br /> ZONING ADMINISTRATORMAI 16 <br /> g <br /> TOWNSHIP PERMITS MAY BE REQUIRED `�""' N"'"« T <br /> I' _ oX4Xt5m� �}5m <br /> `U� --- 88888888 Tri <br />