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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c �t <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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. w m <br /> /G-L/dio 1f 1., m = O <br /> OWNER � I�YY- IY"U � SY2 Yl TELEPHONE - ! S / / L4 -4 <br /> �� y M <br /> ADDRESS (s <br /> EMERGENCY/FIRE NUMBERS ROAD NAME XJ !I✓� <br /> ���,� La kf YI>r�+ <br /> LEGAL DESCRIPTION (see tax receipt) V� <br /> SW y)/R l; w tci# vl ) 7 �3 oy�o <br /> CONTRACTOR t-0 V2-- SE 6k PCL <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> Cctb' v. �y 1 r <br /> STRUCTURE/ADDITION USE: ( ��c-T� �rP—V�'G(- I IP _ OQ'} t l�) o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;a .) Z o <br /> O 9 <br /> R <br /> 3 <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). I o <br /> 3. Show dimensions infeet ofthefollowing:(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 b, signed antl <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 rn <br /> PLOT PLAN Z <br /> r 0 <br /> C <br /> � m t� <br /> JEI� �a <br /> I 0 <br /> 0 <br /> MCLwY1 0 <br /> B Lake <br /> ST Q <br /> n F I� <br /> Z <br /> r'I ;,t <br /> -lam <br /> N —R 000a <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a F - ? Z'z <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, m n C <br /> go <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 8 <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 vI p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 8 <br /> M m <br /> SIGN HERE <br /> i'n re f owner building contracto nn <br /> ZONING ADMINISTRATOR <br /> TO2 J WNSHIP PERMITS MAY BE REOUI ag��1� r^[ IWL <br /> ,AJI\ y��y��//� <br /> 88888888rmn <br />