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c&y <br /> Burnett County 7410 Co. I Id. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w - 0 0 <br /> APPLI ATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the m mXN <br /> Burnett County Land Use Ordin nce, Sanitation Code, and with all other applicable County Ordinances and the laws andregulations of the State of Wisc nsin. <br /> OWNER �� J �au TELEPHONE ��2 5/j& _�3 P <br /> ADDRESS j, �! 7 BRIPC-Fruac+,P 7FRR V D.VA4/s H7-S 351D- <br /> 8 Y3 y LL/ES7 /¢t t,eA ,ed,f i <br /> EMERGENCY/FIRE NUMBER ROAD NAME — <br /> 4C�y Siu� (� <br /> LEGAL DESCRIPTION (see tax ret ipt)Ao—/-7 /'LRT.rf Aot,,E B4KS A/t Fri SFC -rNON / <br /> /4 <br /> CONTRACTOR S CL <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION X o <br /> a O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> STRUCTURE/ADDITION USE: t—C o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and slzt of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 4 <br /> 3. Show dimensions in feet of he following:(a)building to all lot lines,(b)building to center line of road,(c)building -0 <br /> measurement to the ordina y high water mark of lake, stream, or river. Q <br /> 4. If separate plans are submi fted by an architect,engineer,builder,contractor,etc.,the plans must be signed and - <br /> dated by the owner. 0o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o rn <br /> 7i Z o <br /> PLOT PLAN 0a <br /> scF 47- 74CffS IAn <br /> N <br /> fill /T—^ <br /> I <br /> N <br /> n <br /> 0 <br /> 0 1 <br /> o � <br /> z <br /> f <br /> M r 9 aF m <br /> m $� ''2. <br /> o m '<.: c8 o' 3 <br /> CONDITIONS OF PERMIT: <_ m `z � �' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f T'z : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> m 62 :Fa: m <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ao� �-.•`�E <br /> C <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- o m <br /> edge and belief it is true,corren and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- w m T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �' v R B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I E $� <br /> further accept all liability whit I 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 COL my officials charged with administering county ordinances or other authorized person to have m <br /> access to the above describec premises at any reasonable time for the purpose of inspection. <br /> tD m <br /> SIGN HERE <br /> N: <br /> (s gn re of owner orb ilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> x <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N �� m <br /> $ $ $ 8S8vr <br /> 0 <br />