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Ncelp . <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'o Z <br /> APPLICATION FOR - LAND USE - PERMITS '-- 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and rn a <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 n <br /> regulations of the State of Wisconsin. <br /> OWNER <br /> o�1U2- 1 T 7/ 3 / <br /> ADDRESS SSl n <br /> EMERGENCY/FIRE NUMBER o7 /SROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> _ l ' <br /> CONTRACTOR <br /> / E'4 CIO <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTUREADDITION p <br /> n G7 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: }{OY�P i �/ r, �,`!�a G�°� o <br /> (Home/Cabin;CommercialBusiness: Bedroom,-beck; Cc� ' <br /> z <br /> 0 o0 <br /> �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). <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions infeet of thefollowing:(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 1 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 w <br /> PLOT PLAN <br /> N'4.. 12 De fk�`•'' m ° n <br /> -1 s <br /> C <br /> M <br /> -------------- <br /> j\- <br /> 41 Z <br /> fl�o<ss Ria <br /> i <br /> � (�fnv(nr DDoy <br /> y > > � a� m <br /> CONDITIONS OF PERMIT: - 1 I! a m y._ C p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e F 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =In: <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> ud'i G)2 : m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- . 2 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 rem n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ig o : p <br /> mahon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o� <br /> o : <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 N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. = m b a - <br /> 30R- <br /> A 0 <br /> SIGN HER <br /> (signature of owner or 409 ontr - -�tfal yley- -_ �., E wN - <br /> of �: <br /> E i <br /> ZONING ADMINISTRATOR / - E $ <br /> r19 <br /> 4, <br /> TOWNS IP PERMITS MAY BE REQUIRED0 0 .0 _ .0 .0 d <br /> 1 O NNNNNp � <br /> �,_ 0000 000 m <br />