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Vii �./•' "� / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminitrator m o o c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work doscril ed and Q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiromen s of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the h we and <br /> regulations of the State of Wisconsin. m ac <br /> m m <br /> OWNER TELEPHONE Q E <br /> O � � <br /> m � <br /> ADDRESS ' ' Q <br /> � Je//c GST S' / 3 � <br /> EMERGENCY/FIRE NUMBER / ROAD NAME C' 6/� Aod <br /> LEGAL DESCRIPTION (see tax receipt) C/ G S'-35-T5�O.0 k /.5 GJ /)c. g cn <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p S <br /> SANITARY .7' PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> m ~ <br /> STRUCTURE/ADDITION USE: -57i9 /U r f A r^ 0 _ p <br /> (Home/Cabin;Comme tial Business;Be room;Deck;etc.) Z <br /> P o <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) t h <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Nort (N). `- <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c) uilding <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 siged and M ar <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE E SUED. 44 3 m <br /> PLOT PLAN c ; <br /> C II <br /> I <br /> q� <br /> in <br /> \ n <br /> O LQ <br /> � A <br /> m <br /> O � <br /> w <br /> l Z <br /> Isom <br /> CONDITIONS OF PERMIT: C a g' ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f - Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - - y ? 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' n m <br /> a C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of 1 ny knowl- i <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al I informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that Ihis infor- S p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue i permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ` p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> m � PPP <br /> SIGN HERE Ar�� -�io �� <br /> (signature of ow o 1 9 nt (d a) <br /> ZONING ADMINISTRATOR <br /> TOWN IP PERMITS MAY BE REQUIRED pM~M~M~H �m <br /> 4X f� i5 N i>;i5 <br /> $ $ $ $$$ 8$ UM) <br />