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ie�)j may) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q m On <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer Is of the o c SLU <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the I aws and O 9 <br /> regulations of the State of Wisconsin. w m <br /> m o <br /> OWNER O S fir. <br /> d�1J .l TELEPHONE <br /> J �J 5511 <br /> ADDRESS 'a 0 f Otytt UI e1J 0;r eec4e' / ti <br /> c��^ 1 <br /> EMERGENCY/FIRE NUMBER 3J b ROAD NAME <br /> f <br /> LEGAL DESCRIPTION (sae tax raceipt) 3 7?/6 CJ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE V ADDITION p <br /> CA <br /> n o0 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: �SCY�e.� '-�p Lt.cS Q— O 13l 0 0° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> o <br /> m <br /> a <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 Ni and indicate North (N). <br /> 2. Show the location of the well (N),septic tank (ST), and drainfield (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 <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 all;ned and 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE i 7I v um <br /> PLOT PLAN oC IDS <br /> n <br /> M o <br /> See <br /> w <br /> (� <br /> ° <br /> 7 <br /> 0 If <br /> tl W <br /> O � <br /> w <br /> n <br /> 2C-1 <br /> 9 <br /> 1 <br /> CONDITIONS OF PERMIT: v 3_. cffi g� X1$ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =t2 E 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" Q In <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- f o' C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of a I 1 informs- ~ �+ 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. $`Q $ <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.1 agree to permit county officiate charged with administering county ordinances or other authorized person to have <br /> 0: <br /> access to the above described promises t any reasonable time for the purpose of inspection. @ <br /> SIGN HERE - <br /> o atm f owner or building contractor) (date) ~` <br /> ZONING ADMINISTRATOR I <br /> ~. ~ <br /> TOWNSHIP PERMITS MAY BE REQUIRED o a(X S5. $ m <br /> $ $ $ $ $ $$ W <br />