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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator f <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <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 1 <br /> regulations of the State of Wisconsin. w m <br /> c u <br /> O <br /> OWNERc TELEPHONE (� <br /> m <br /> ADDRESSctrn_-455�.hJ(I(�� <br /> EMERGENCY/FIRE NUMBER lo -2641 ROAD NAME <br /> "' fl <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR GCy r Q dvzy� l -75 X0"h Rd. 6(a. bL10af g(b'zto <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ o <br /> c1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> LL <br /> `/ / kao/ w <br /> STRUCTURE/ADDITION USE: DPA F� ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z p (� <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). C} <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 <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. v va <br /> Z a <br /> PLOT PLAN o a <br /> Ste `` ue. F o <br /> a �} <br /> N ' <br /> m <br /> � y <br /> �`) 2 XI Sfi1,15� <br /> s �J <br /> _ f <br /> cJ JQ <br /> R `�_� �S� �D>f m <br /> m. g� - a� o m <br /> I v az . Bye $ <br /> CONDITIONS OF PERMIT: Z o' ''. -R Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIR MENTS WI HIN fi0 DAYS OF PERMIT ISSUANCE. <br /> 2. RE G OF TREES AND VEGETATION IS RES ICTED ALONG SHORELINE. - •� ' ' - �gy` M <br /> 3. NO GRADING OR SH RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L' O tS i p <br /> qqEE <br /> I doctor th (including any accompanying schedule)has been examined by me and to the best of my knowl- N m <br /> edge lief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• ?S <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- v 6 p <br /> 88 <br /> furtha I liability which may De a result of the County of Burnett relying on this information I am providing in this <br /> plicati to permit county officials charged with administering county ordinances or other authorized person to have <br /> acesee to the vs describetl promises at any reasonable time for the purpose of Inspection. r <br /> (1 ) n �+ <br /> VIS �c <br /> SIGN HERE ` g: <br /> pignat owner or but in or buI in contracto0�l�." 25 <br /> ZONING ADMINISTRATOR N <br /> TOWNSHIP PERMIT MAY BE REQUIRED ! AUG I 01%4 ~ R N198 m <br /> 888888'8'8 fn <br />