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IN cDrf\,Pl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> W ° <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 $ C <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 <br /> Wisconsin. <br /> "/ y 7 L /' 1\f`p q Q�/� / / /(�/, w m_ <br /> OWNERS Er? P l I Ui-150 Q fthp D �AriJO(y TELEPHONE(b ',f/7 ,I�h'-1d,7b d' Cb�t 7ro a 0 £ <br /> ADDRESS y9�� WA sF6urn A ve N fh Pt_r1Mfj SS 136 C'cW 41-pon f Avt N tkced-ek /h4' a t <br /> EMERGENCY/FIRE NUMBER ROADNAME SfY7� '7J <br /> y wAr� burn Gane ,p �� � <br /> LEGAL DESCRIPTION (seetexreceipt)7��,t �f of Cr✓r �Vfiai ��- d-1S��es;yrate/Prtor3P( yr/,7 '-3'/y,, <br /> p_ <br /> CONTRACTOR k 4r-V <br /> TYPE OF PERMIT(S): DWELLING//BUILDING GARAGE/ACCESSORY STRUCTURE C ADDITION p Irl 1 <br /> � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> /5k 1/ W f 0 r J f <br /> STRUCTURE/ADDITION USE: ° <br /> (Home abi ;Commerciall Business;Bedroom;Deck;etc.) Z o •%� <br /> 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <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 dralnfield (DF). <br /> 3. Show dimensions In feet ofthe 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 J <br /> dated by the owner. i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> PLOT PLAN <br /> m � = <br /> 00� <br /> I t O C <br /> NS �} N <br /> T w d <br /> C� <br /> o <br /> Ji <br /> a � <br /> rf,j d01 <br /> o c m n F � <br /> CONDITIONS OF PERMIT: u o ,p 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = o o m 4 : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P £ ' r M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C ` m0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> informs <br /> g m m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all <br /> rn <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i i i g <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue apermit. I 8 a 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 ~ <br /> access to the above described premises at any reasonable time for the purpose of inspection. a , <br /> i a A <br /> SIGN HERE �° l <br /> gn ure ofowp �or b i ding contractor) (date) a E <br /> � 8 ; <br /> g <br /> ZONING ADMINISTRATOR <br /> v h+ife"m�NN m <br /> TOWNSHIP WRMITS MAYBE REQUIRED Yi u u v v o o , rn <br /> 88888888th <br />