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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Adminli trstor sw m V/f� o <br /> APPLICATION FOR — LAND USE — PERMITS s <br /> c <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descrided and v m -s <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremeni a of the e c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ Q <br /> regulations of the Slate of Wisconsin. v m_ <br /> g o <br /> OWNER TELEPHONE E <br /> �_. / / p E <br /> ADDRESS `P/�>LLf h A-K\r'e /I L e< e. xe <br /> N <br /> EMERGENCY/FIRE NUMBER ROAD NAME C-o <br /> � <br /> LEGAL DESCRIPTION (see tax receipt) ..$•W r p V V &�✓ a /�.- /iq.�t1 e^/ N <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o O< <br /> �STRUCTURE/ADDITION USE: /� /¢�� / ullJ ` o r <br /> (Home/Cabin;Commer ' I Business;Bedro ;Deck;etc.) z o <br /> IOp0 p <br /> } <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 Nort (N). r <br /> 2. Show the location of the well (W),septic tank(ST),and drainfleld (DF). 4 <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building I p <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 al ned and M <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE I ZUED. 1A 3 m <br /> 41 2 c <br /> PLOT PLAN ° <br /> O <br /> S � M � <br /> ,P._�� 4x1 <br /> 1 <br /> • <br /> r <br /> 0 <br /> m <br /> w <br /> Z <br /> Imo\ <br /> M <br /> g� -.a & 31 <br /> CONDITIONS OF PERMIT: o' <br /> R.: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUrnNG OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E za N' 33 <br /> 3. NO GRADING OR SHOREUIND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best o my knowl• E ? m <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 <br /> ■ <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize lh this Infor. <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I $ $ S <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providini In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized per n to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. r <br /> i <br /> SIGN HERE Gr/,�r�e_ F/ - o X, <br /> (signature of ow o II tractor) ( <br /> ZONING ADMINISTRATOR 3 t ? Ng . <br /> o ' <br /> m <br /> NSHIP PERMITS MAY BE REQUIRED . . . N. a8888i <br />