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euumett County 7410 Co. Flld. K, No. 102, Siren, WI 54872 Office of Zoning Administrator !u) f C o <br /> APPLICATION FOR — LAND USE — PERMITS -- <br /> TO THE ZONING ADMINIS OR:The undersigned hereby makes application for a Permit for the work described and u <br /> located as shown herein. The ndersigned agrees that all work shallbe done in accordance with the requirements of the - <br /> Burnett County Land Use Ordir ance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisc nsin. w m <br /> u m <br /> OWNER TELEPHONE cm <br /> `f) E <br /> r Q T mo <br /> SL! I <br /> ADDRESS3. - 14 <br /> fjo S <br /> EMERGENCY/FIRE NUMBERaC-,?U - ROAD NAME CJuI N <br /> LEGAL DESCRIPTION (see tax receipt) <br /> J / <br /> CONTRACTOR y <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_� p <br /> n u7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> 0 <br /> m r STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLA 4 DRAWING: (Aerial or top view) <br /> 1. Show the location and alzi ,of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the v ell (111 ,septic tank (ST),and drainfield (DIF). <br /> 3. Show dimensions Infest of he following:(a)building to all lot lines,(b)building to center line of road,(c)building .1 <br /> measurement to the ordinalry high water mark of lake,stream, or river. C <br /> 4. If separate plans are subm tted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 3 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOVIWNS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMrr CAN BE ISSUED. 'w a y <br /> PLOT PLANo box n / / ? o n <br /> `� re-,, <br /> e N: <br /> 0 <br /> nl UJ <br /> 6c.t�ge <br /> vh Q <br /> ec1le- <br /> t , <br /> u. ¢ a)¢,1 5M 71 p <br /> 1—i No an.y ILS! Ir 2 <br /> 17c4�n��el1 Z <br /> eo , N f <br /> 'gym <br /> 0 <br /> CONDITIONS OF PERMIT: 8 g ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = e Zil <br /> 8 Q [ <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p E ` a <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. In <br /> i '. O i m <br /> C <br /> I declare that this application(I icluding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,corm t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this applicati n(including any accompanying schedule)and I further doctors that I recognize that this infor- �? E i$ $ i C <br /> motion I am providing will be lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i $ <br /> further accept all liability whicl 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 ' <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE J A0 /9 <br /> (a nature of owner or building contractor) (data) <br /> ZONING ADMINISTRATOR $ E <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 88888188 a, <br />