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k-/ �MY41� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to <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 � a <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 2 s <br /> regulations of the State of Wisconsin. w m <br /> m <br /> n O <br /> OWNER � '+ 'P S/VD (fJ Line,-rlSon� M@kCoTELEPHONE gra�o 78y O = <br /> f� n ccll <br /> ADDRESS FS /-5- C-6-6 V er P,s i n+ R ocicl. <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Py <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> '- 1� <br /> r <br /> STRUCTURE/ADDITION USE: Dar �� — � - � - � o °_ Q) <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> Z o <br /> 0 c <br /> m <br /> a <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. <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 i? <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. It o y <br /> PLOT PLAN N A o a <br /> C o <br /> t m <br /> (tie <br /> O oIN ` <br /> to F <br /> Vf / — b�� o <br /> C, <br /> � m <br /> Tk <br /> Z <br /> sept-,`ai' n <br /> 2� 3Al -4- <br /> C3,-.p <br /> rG,P R <br /> e.r 1'D ROQCQ MRscf�rl <br /> a $v� a m <br /> CONDITIONS OF PERMR: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? E it ' <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. �' Q�, E In <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 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- «m"' m <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. 1 91 $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing ii this ap- ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have i i 0j p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ' <br /> '2 <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) « <br /> ZONING ADMINISTRATOR /fin- l <br /> TOWNSHIP PERMITS MAY BE REQUIRED C N N«N ro 5«« T <br /> 8u, u, 8m <br /> $ 88 $888 $ mw <br />