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C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o a <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m o <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and - H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 v 1 <br /> regulations of the State of Wisconsin. - o <br /> OWNERW/////4;V'„/ J �z7alPl+S0Al TELEPHONE Gi 9 - -5-,F <br /> O <br /> ADDRESSa c7c 17 171 <br /> 71- 1a ke Zd c'l C/ / ?OUi Shia 5 <br /> EMERGENCY/FIRE NUMBER �' a 9 f ROAD NAME /l e Rd, <br /> LEGAL DESCRIPTION (see tax receipt) / W <br /> CONTRACTOR `,U/,/Gax1-710 97 4- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> 0 <br /> SANITARY PRIVY FILLIN�G/GnRA7DIINlG�^ CAMPING UNIT SUBDIVISION a ° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) _ I <br /> o ° <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 /> 2. Show the location of the well (W),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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 3 N <br /> PLOT PLAN o n <br /> vori <br /> SU <br /> y1 <br /> s a61 <br /> rV) �a <br /> J <br /> 0 <br /> O <br /> J <br /> Eed <br /> m 00 Im <br /> gl* J- a m a m m <br /> CONDITIONS OF PERMIT: lull 9 m N. ,z CS 0 T� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m 5 I �� -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ � =y' M <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. T I 6 n m <br /> c [ s O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- °'. i <br /> C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs i i "I «. Im <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. �' a8 <br /> p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ; v g <br /> m m <br /> SIGN HERE ` a <br /> (aitUF6 of owner ilding contactor) (date) r� <br /> ZONING ADMINISTRATOR <br /> t rnwfn�en enww -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N $ 8 N m <br /> 0000880 ,00) <br />