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&L & qj, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m - <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 m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. ;07 533 96,S LI <br /> 0 <br /> w g <br /> a m <br /> OWNER Cy'► c cE- C NAS f C. v &JeAfSQM TELEPHONE g �p� ` O 7S/ a £ <br /> ADDRESS V S S l v I �,Le �/ S-7 7 7� 0 a <br /> (� M <br /> EMERGENCY/FIRE NUMBER �� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> I / ^ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: 0 g <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z :? <br /> 0 0 <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). g <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1111rn <br /> � .Z <br /> o o — <br /> PLOT PLAN A <�I <br /> � ro5 'C� • 1.1`7 � ao <br /> I <br /> 1 I <br /> ' <br /> .ii61 <br /> a <br /> �32, TTALK 1►JE Z1G25% N 0 <br /> d <br /> z <br /> DRAW <br /> foo }�- <br /> FIe.LD <br /> o 42a0 ' <br /> `d '- m 33 <br /> CONDITIONS OF PERMIT: v �; `� C B g� ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 o 'z <br /> fes ur <br /> . <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. g M <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rnO k m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowI- r <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- •+a •+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- of p <br /> matron I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in thia ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) yyqq <br /> ZONING ADMINISTRATOR 7—lAn <br /> MM+�MN.N+� T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N 4X S4;o"i Nl6 m <br /> 88888888 vi <br />