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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � o �Z <br /> APPLICATION FOR — LAND USE — PERMITS2. <br /> . >E — <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes <br /> 9 by application for a Permit for the work described and 'Z w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 <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. a m `\N <br /> OWNER eV14�, YEPHONES O <br /> � <br /> . fe025 <br /> ADDRESS <br /> JS n o £ <br /> P Re ev k1 <br /> EMERGENCY/FIRE NUMBER / 5 ROAD NAME BUS/J E /\ O 4 C7 ) <br /> r'�rr <br /> LEGAL DESCRIPTION (see tax receipt) �Q I SeG d-J/ <br /> CONTRACTOR <br /> I "b <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> STRUCTURE/ADDITION USE: UnkftWrQ / 6��tDUK $�A=iZ g <br /> (Home/Cabin;Commercial Business;Bedroom; eck;etc.) Z <br /> o 'o <br /> 9 <br /> R <br /> l <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 (f). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 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 -4 <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 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN3 y <br /> PLOT PLAN7I 'Z v <br /> o n <br /> M <br /> v tib C a <br /> m z <br /> I If 00 <br /> 39 <br /> 5 p <br /> N N <br /> O ('n <br /> !� <br /> � t as ' o <br /> v � <br /> ---- W>u� 311 <br /> S3n*ibi� P(6 <br /> F1270 m <br /> Z cD o.'� not o M <br /> CONDITIONS OF PERMIT: ([' ZW c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z u o w e o Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a f = T N : M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Yri':, : m <br /> n <br /> g : c ' C <br /> : m 0 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 0 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m y!m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- S a m <br /> motion 1 em providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $u <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this - <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have w <br /> access to the above described premises at any reasonable time for the purpose of Inspection. i m <br /> ar - a A d <br /> SIGN HERE /47 YL / - w $ <br /> (signature of own o ull I co r 6011 (d 18 ` a <br /> € $ ; <br /> ZONING ADMINISTRATOR <br /> TOWN IP PERMITS MAY BE REQUIRED m <br /> oTn u, vt ut utoo . m <br /> 888 $ $ $ $ $ '0 <br />