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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorcn 0 c a <br /> APPLICATION FOR — LAND USE — PERMITS 3, <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described andI i.., <br /> located as shown herein. The ndersigned agrees that all work shall be done in accordance with the requirements of the m ,�4, <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 /> N O <br /> OWNER TELEPHONE n ` ) <br /> 1�daA� LoOIrG C !Z 3 r L <br /> �/ a <br /> ADDRESS 7 Uy '^ <br /> S� <br /> EMERGENCY/FIRE NUMBERF'90 jr— AROAD NAMAE `!lam <br /> LEGAL DESCRIPTION (see tax re � D ipt) 3o /�p eoulvj (Li N <br /> vert A" .1 <br /> u� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING y GARAGE/ACCESSORY STRUCTURE ADDITION p (�-- <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> O <br /> r- <br /> STRUCTURE/ADDITION USE: CC- <br /> (Home/Cabin; <br /> C(Home/Cabin;Commercial Business; Bedroom; Deck; etc.) Z m <br /> ° 0 � J <br /> a <br /> DIRECTIONS FOR PLOT PLA14 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 ell (W),septic tank(ST),and drainfield (DF). 0 <br /> 3. Show dimensions In feet of hefollowing:(a) bulldingto 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. Q y <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed andy <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> c <br /> PLOT PLAN �t✓� A o n <br /> 13✓r -- ° <br /> C \ <br /> 111 FI ''iJ <br /> O0 <br /> iJ <br /> GAp�' lA� o <br /> a <br /> �o� v <br /> n <br /> 3001 oa Z <br /> i D <br /> fn V rDDO y <br /> A . F� 2.amemy <br /> GiNw r e <br /> CONDITIONS OF PERMIT: '^ m y.; 9 C 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o': Q ' - <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F - �—�—N p i <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(i icluding any accompanying schedule)has been examined by me and to the best of my knowl- t� <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a p <br /> motion I am providing will be ielied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability whict may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit cou ty 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. r ; �$ <br /> C <br /> SIGN HERE <br /> (si naaa�f own r or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> H' k X <br /> to usa-r rn m,MdcT <br /> TOWNSHIP RMITS MAY BE REQUIRED m <br /> ` ssos m <br /> 0 <br />