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J�L 66)4 1 ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <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 /> m m <br /> m <br /> C <br /> OWNER,' ���rrlll f���l,,,��((/�,,,L" /�uC�` TELEPHONE <br /> y <br /> ADDRESS �r'x�.n" 44 11 '�UR�.7 LK- gip- �RNStIR� � 71�3� 0 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p y—.-� <br /> 0 L /ll�l <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° .l <br /> o < <br /> m r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Zv <br /> ° o <br /> 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 drainfield (DF), o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 N <br /> PLOT PLAN ��- oILI <br /> a <br /> w <br /> /97Tpc��n '" <br /> I <br /> m <br /> ° <br /> 0 <br /> o <br /> y <br /> N <br /> Z <br /> a <br /> f <br /> M �NvSnrDDoy <br /> c '.> > nqf m <br /> CONDITIONS OF PERMIT: a m y:: '2 CS fir S 5' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m� so <br /> . 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f =N >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. S«n a)2 : m <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.1 acknowledge that I am responsible for the detail and accuracy of all informa- «w a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- o : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I : o� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a -- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 0N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. - <br /> m v AA m�€ <br /> m m <br /> SIGN HERE ff 11-23 � <br /> (sign tura of owner or b 'Id' g c recto (data) i N i - <br /> rd1 x? E <br /> ZONING ADMINISTRATOR ��'�"'t / /��? �� $ : <br /> ««� ««« <br /> TOWNSHIP PERMITS MAY BE REQUIRED "' N N g N In m <br /> $ 0 $$ $ mf/1 <br />