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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office o Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PEROSOMPU . <br /> �r 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. o <br /> w m <br /> m m <br /> c <br /> OWNER I { 4rnd f! TELEPHONE �Y c� '��U4 n £ <br /> m 1p <br /> ADDRESS S IGS .5 fu 5rl" <br /> EMERGENCY/FIRE NUMBER 6�y � ROADNAME �! <br /> a e- <br /> LEGAL DESCRIPTION (see tax receipt) // L <br /> CONTRACTORO <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ p �D <br /> I <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° T- <br /> - a <br /> STRUCTURE/ADDITION USE: L/165P I A ��'L n, Jc r)-v, J 0 rX'�Q / o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z O <br /> 0 0 <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 (NB) and Indicate North (N). U3 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). ® o <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 'A <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in 3 y <br /> PLOT PLAN Z <br /> LL o n <br /> 9 I K° Ill oQ N: <br /> C . <br /> 0 <br /> I <br /> 75 <br /> 3' <br /> K E' 9 <br /> %A D <br /> �1 <br /> N <br /> L t� � <br /> 1 �ro tifi I--o 1 �- <br /> m <br /> 5 —r) <br /> 10 <br /> 6^rAy yp Z <br /> I <br /> Of4r^�, f 1 <br /> rnrn r D> 11 <br /> M <br /> CONDITIONS OF PER - g Wm o m 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E a T•2 . <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ _ M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Iii O m <br /> ro [ O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- - m o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ° E <br /> a �, m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ <br /> Mallon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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 M <br /> access to the above described premises at any reasonable time for the purpose of inspection. m P <br /> m Ei i 3 $ <br /> m : o AA s <br /> SIGN HERE <br /> igr)a1u of own" r uildinq contractor) (date) a <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER ITS MAY BE REOUIRED o Z U o c m <br /> �-888888886 <br />