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sjl iKi}� �i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 a f o <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> m s � <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 V <br /> 0 <br /> regulations of the State of Wisconsin. <br /> h n E <br /> OWNER VA C 1 K TELEPHONE 2✓ 9 — JU5 m -� <br /> ADDRESSCJ � C> <br /> EMERGENCY/FIRE NUMBER Q c7 <br /> 0C3 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION/_ o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 °_ <br /> STRUCTUREJADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o 'o <br /> 9 <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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). ° <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building O <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 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. �I v m <br /> PLOT PLAN o <br /> a <br /> C � <br /> m <br /> Se <br /> r; 07 <br /> m <br /> Cao <br /> o <br /> y I v <br /> '2"`v Z <br /> J 7J <br /> C <br /> o c m m o n E T <br /> o- <br /> « _ Q '- nm m <br /> CONDITIONS OF PERMIT: « ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY : oAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f : Q -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i ' Q ; m0 <br /> gC <br /> I declare that this application(including anY accompanying schedule)has been examined by me and to the best of my knowl- : u m O. 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- y!m �+: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ` 25 o ut p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ « 8 <br /> further accept all liability which 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 county officials charged with administering county ordinances or other authorized person to have O n� <br /> S € <br /> access to the above described premises at any reasonable time for the purpose of inspection. T , ; 3 $ F <br /> m u A « <br /> SIGN HERE - .zi <br /> A <br /> 8 : <br /> D <br /> (al at f own uilEing contractor) (date) -- p <br /> /6' ' 8 ` � <br /> ZONING ADMINISTRATOR TOWNSHIP PERMITS MAY BE REQUIRED T <br /> OCT 201992 ssssass8y <br />