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ON COMPUTE SCA NOP �J <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, Wi 54872 Office of Zoning Admil listrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO'THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work clear ribed and ie <br /> located as shown herein. The undersigned agrees that all work shell be done in accordance with the requiremi ints of the m �� <br /> Burnett County Land Use Ordinance.Sanitation Code,and with all other applicable County Ordinances and th laws and 3 <br /> regulations of the State of Wisconsin. o <br /> lm m l0 O <br /> TELEPHONE <br /> &0 -9 -05 e o n <br /> 0 _/ Jd m `° <br /> ADDRESS 00 <br /> D o <br /> y <br /> EMERGENCY/FIRE NUMBER I2 <br /> LEGAL DESCRIPTION (seetu receipt) � ifd y� <br /> CONTRACTOR ) JJ <br /> W�A4QPAl./1A j�U4 !da /96�viLdl <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_.� GARAGE/ACCESSORY STRUCTURE ADDITION p G <br /> O <br /> SANITARY i�/�-r PRIVY FILLING/GRADING CAMPING UNIT/ SUBDIVISION o 0 <br /> (Nt also n.edfk;. pti.Kd fw) j—� <br /> m - <br /> STRUCTURE/ADDITION USE: d7..¢- .Yr' 'F n" S-I-YS'+ o gr ('0 <br /> (Home/ abin;Commercial Business;Bedroom;Deck;etc.) v <br /> z <br /> 0 o r <br /> 0 _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> „1YShow the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> ( Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 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. C <br /> ,)measurement <br /> If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s gned and A <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 0 / <br /> PLOT PLAN ^/ n o a <br /> �f <br /> r lade <br /> 1 C <br /> 111 <br /> 1_itIx�:,y <br /> C� dr� JT CA <br /> Sit a r) <br /> sitCpC ot1 01 �a ca:l� vu <br /> 9-1 <br /> ma <br /> f <br /> CONDITIONS OF PERMIT: g m 118 <br /> g 0' <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m S': �`Z —1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P =N i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V: a g m <br /> ' <br /> ffi E ` E C <br /> I declare that this application(including any accompanying _ <br /> schedule)has been examined by me and to the best o my knowl- o <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of II informs. �' " «m a <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- $ B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe on to have o <br /> access to the above described promises at any reasonable time for the purpose of inspection. ' m <br /> m <br /> SIGN HERE - ` p <br /> (signature of owner 7b ildf co toi (date) <br /> JYIt <br /> ZONING ADMINISTRATOR <br /> TOWNSNI RINITS AY 8E REG -RED �+ N <br />