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Burnett County7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes 4 <br /> 9 by application for Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m WE <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and ().) <br /> regulations of the State of Wisconsin. = o L <br /> w m <br /> b 0^ <br /> OWNER M QyA I TELEPHONEa E <br /> ADDRESS E/U /'T -S <br /> O <br /> EMERGENCY/FIRE NUMBER y 8, ROAD NAME76) <br /> zr <br /> LEGAL DESCRIPTION (see tax receipt) T37-0 p�d W / '1 <br /> A /17ee.ya/v <br /> CONTRACTOR Ct <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY 7L. PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION r^ o <br /> _/ o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; edroom;Deck;etc.) Z o <br /> 0 o I <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). Iv <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). I <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)buildingtJ. <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 0 • <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 O <br /> PLOT PLAN n c g <br /> M Q <br /> C <br /> a <br /> M t <br /> vi <br /> o N <br /> U o <br /> _ <br /> 3 <br /> m <br /> O y <br /> MV <br /> a <br /> 2 <br /> f <br /> f <br /> CONDITIONS OF PERMIT: $ A R.w - z$ C"' g 9 <br /> x = <br /> gee � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. o ' �Z -f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '• N i i ' m <br /> ' D <br /> PP (including Yaccompanying 1 Y Y O' 1 <br /> I declare that this application mcludin an schedule has been examined b me and to the best of m knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 4�"14 .+m «.; <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- 1 v 8 <br /> matlon 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 O` p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN MERE r 9 9 : <br /> (signature of owner or bull e rdale) <br /> ZONING ADMINISTRATOR 7/167Zo8 : <br /> i $ i <br /> o� f5N4Xi5m <br /> TOWNSHIP P RMITS MAY BE REQUIRED <br /> 888888880 <br />