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e1 coy-lip <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator N m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c .Sli <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. m <br /> J m' <br /> OWNER A //6N� A_ L yO TELEPHONE <br /> ADDRESS tl -)W- / g <br /> EMERGENCY/FIRE NUMBER / ROAD NAME (7eyar f1l, [7�J <br /> LEGAL DESCRIPTION (see tax receipt) CoL) 46F,5- 1-01403 Ue I 15-P4 elyq7 5B0To7,7w1 w O <br /> CONTRACTOR 1/-A D<' wiL+S'��10 W S <br /> 5 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> n 0 I� <br /> SANITARY ` PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> STRUCTURE/ADDITION USE: —S;4/tJ i /+ r r-y 117 <br /> (Home/Cabin;Commerci usiness;Bedroom; eck;etc.) Z <br /> ° o <br /> 0 <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). w <br /> 2. Show the location of the well ,septic tank (ST),and dreinfield (DF). O 5 <br /> 3. Show dimensions in feet of the 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 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 3 <br /> PLOT PLAN o <br /> C W o <br /> II <br /> O <br /> I <br /> O Z <br /> W (n <br /> n <br /> W � � <br /> o G I' <br /> 0 <br /> o � <br /> w <br /> Z <br /> 1 � <br /> f <br /> 0 a O m <br /> CONDITIONS OF PERMIT: = R.: CC- <br /> 1. <br /> c-1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r»' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �+' : O Lr <br /> fn <br /> PP (including Y accompanying 1 Y Y <br /> : C <br /> 1 declare that this application mcludin an aceompan in schedule has been examined b me and to the best of m knowl- iR : E !E <br /> edge and belief it is true,correct and complete.1 acknowledge that 1 am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- (S': <br /> motion 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 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 - p <br /> access to the above described promises at any reasonable time for the purpose of inspection. CD <br /> SIGN HERE 20 <br /> .n: E <br /> (signature of owner r bui ingc r) Ida ) <br /> ZONING ADMINISTRATOR Z ' 8 E <br /> TO SNIP PERMITS MAY BE REOUIRED8m <br /> AIW99998g <br /> 8u) <br />