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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 'v E <br /> w c <br /> APPLICATION FOR — LAND USE — PERMITS m . <br /> TO THE ZONING ADMINISTRATOR:The undersigned here app C� <br /> g by makes application for a Perms for the work described and '� w <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 f <br /> regulations of the State of Wisconsin. a V 1 <br /> c !t <br /> �n m <br /> OWNER n+ f"t - 1 TELEPHONE _ a3- 9 `1 <br /> 1 ` I'i trill O m <br /> / m <br /> ADDRESS — aao 1' <br /> EMERGENCY/FIRE NUMBER ROAD NAME ) <br /> n u <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) Lc, -(- � C S m I S <br /> CONTRACTOR LA <br /> TYPE OFPER DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 10 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: <br /> or bin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> o ° <br /> 0 <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). o <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. <br /> 4. it separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a y <br /> PLOT PLAN an z $ <br /> fJd � <br /> LAY � I yv5 C ) <br /> M � <br /> 1 <br /> " <br /> Decr _I� <br /> dS <br /> o <br /> o <br /> � �a IVB 4' � -!•Or \ �/1� -J{- <br /> ; <br /> /� 4U�fi s�tl� 'c Ase <br /> �ynl�Uw�cl- <br /> z <br /> F. T be sae,P�/ <br /> a- <br /> �o or fs <br /> below OrcQ� F-h5/�S � <br /> f m. D$� �a� egM <br /> CONDITIONS OF PERMIT: �'�` = � v y.: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 5' I -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i m <br /> I declare that this application(including an accompanyingschedule)has been examined b me and to the best of <br /> i Fr ' C <br /> PD ( g Y Y Y knOwl <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all infol ^` " m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infory B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized pe n to have p <br /> access to the above described premises at any reasonable time for the Purpose of inspection. <br /> 3m <br /> SIGN HERE <br /> a <br /> a: <br /> (gig to of w or Ing contractor) date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE ITS MAY BE REQUIRED i SEP 2 Q 5 0 g R98 8 m <br /> jai 8'8888888 U) <br />