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Burnett Countr7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 — <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the r^ <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. N m Q <br /> I1/ ! - 1 [ n O <br /> OWNER-:-II�IiC TELEPHONE W. �'t �Sf !1� "S vC UE <br /> 'I r7 m _ <br /> ADDRESS .�(.. Alv 5 1U W 1 <br /> EMERGENCY/FIRE NUMBERROAD NAME ' <br /> n i S_hCx—rv-ce, QCIP <br /> LEGAL DESCRIPTION (see tax receipt) /.� L , � St �1 .� (.b;r l� r) <br /> CONTRACTOR lll��J i7) D <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o <br /> Z ° <br /> 0 {� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ` <br /> 0 <br /> �f1C �f15x� ��r N <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z v <br /> o ° <br /> 0 <br /> m <br /> 3 <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). 2 <br /> 3. Show dimensions infeet of thefollowing:(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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> PLOT PLAN 0 <br /> O n <br /> See �71"�7cG�ec� C Q <br /> m - <br /> I i <br /> I <br /> 1 <br /> N <br /> A <br /> ° <br /> O <br /> O <br /> N <br /> 0_ <br /> b <br /> o N� <br /> (Ia5�� `� ^ iiry <br /> �- <br /> �� p we-c,F �(,bs� d — /h <br /> c� lea-lie -t��✓` ���sf� 6A�1.., <br /> y�0 r D D O <br /> e M_ amc = x <br /> D- , � x <br /> CONDITIONS OF PERMIT: m Z 9$ .,o M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN GO DAYS OF PERMIT ISSUANCE. o £ _Q : -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _»1 <br /> �: <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : o : p <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have 0" 0: <br /> access to therpbove described premises at any reasonable time for the purpose of inspection. r 3 00 <br /> o, m 9 A N <br /> fD m A <br /> SIGN HERE <br /> (si atur of owner or Id' g contractor) idate) <br /> ti <br /> o : x: <br /> ZONING ADMINISTRATOR �� <br /> TOWNSHIP PERMITS MAY BE REOUIREDO N N N N N p N m <br /> 00000000N <br />