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O�- cotitg. <br /> f <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord M c o <br /> APPLICATION FOR — LAND USE — PERMITS 3' 0 <br /> 0 <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 unilersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinar ce, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. kp <br /> w � <br /> OWNER Q TELEPHONE r a O <br /> ,1 �3S- � 2_ ( S J F <br /> 7/ <br /> _ SyBo r <br /> ADDRESS /'S7 3 �I T ,4 <br /> EMERGENCY/FIRE NUMBER a ROAD NAME 6'/957 re IC>5� <br /> rWr <br /> LEGAL DESCRIPTION (see tax recei t) <br /> CONTRACTOR Np A/C <br /> TYPE OF PERMIT(S): DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° ') <br /> STRUCTURE/ADDITION USE: ° o r1 <br /> ( ome/Cabin; Commercial Business; edroom; Deck;etc.) Z o <br /> o v <br /> m <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). <br /> r <br /> 2. Show the location of the we I (W),septic tank (ST), and drainfield (DIF). a <br /> 3. Show dimensions in feet of tt efollowing:(a)buildingto all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordina high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitt d by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE'. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 40 o N <br /> c <br /> PLOT PLAN 0 <br /> NtG� La"-�t i <br /> ,oma <br /> �u <br /> 70 yo E 0 OQ <br /> Ea ztW 2� � DM� 3Y t(oRT�' <br /> v� r <br /> 1y Y8 L aq a -A o <br /> Z4rb s q r <br /> 117 <br /> J <br /> 375- <br /> LO Ail <br /> 7stvAiP F0'q_0 <br /> U <br /> J g� a m v= y <br /> 9 - a u <br /> CONDITIONS OF PERMIT: < Z V m -'r'o m- <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o e o T'z <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = n ' <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> N it y ' In <br /> I declare that this application(ir luding any accompanying schedule)has been examined by me and to the best of my knowl. o <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a m m <br /> tion contained in this applicatio I(including any accompanying schedule)and I further declare that I recognize that this infor- 8 a : p <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $'m 'g <br /> further accept all liability which ay be a result of the County of Burnett relying on this information I am providing in this ap- y, <br /> plication.I agree to permit cou y officials charged with administering county ordinances or other authorized person to have i i O N o <br /> access to the above described remises at any reasonable time for the purpose of inspection. 3 0 <br /> arYm : <br /> m <br /> w w m <br /> SIGN HER '^ <br /> (ana re of owner or b i ing contractor) (date) <br /> Pi x f E <br /> ZONING ADMINISTRATOR g <br /> x <br /> TOWNSHIP PERMITS MAY BE REQUIRED $ o o $ Th <br /> w x x x <br /> 0 <br />