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N_ _ CZ"tP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m d � <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and m f r <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a m v <br /> Burnett County Land Use Ordini ince,Sanitation Code,and with all other applicable County Ordinances and the laws and I <br /> regulations of the State of Wiscc nsin. m <br /> a <br /> OWNER TELEPHONE n f <br /> o� X53 <br /> '//, p m <br /> ADDRESS <br /> L. I <br /> EMERGENCY/FIRE NUMBER9Q 2 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Pr7 Q D N <br /> U S 2 11)F2 h EL T <br /> S ,O 2Y /,2 J <br /> CONTRACTOR _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> a G <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> a <br /> N � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commer ial Business;Bedroom:Deck;etc.) Z v <br /> 0 0 <br /> 0 <br /> m <br /> z <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 thew II (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of efollowing:(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 signetl antl <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ONon . to <br /> PLOT PLAN /f = o <br /> C.�� L�/Y'•'�� <br /> y_ ro <br /> C ! <br /> J �/ p✓� t CE ue,- 4- <br /> L)L) <br /> 5 i � <br /> N � ? <br /> O _b0 <br /> m <br /> v <br /> N <br /> W h SRF iT c r <br /> i <br /> f <br /> /zooD ins��0a� <br /> m, pEr..l 2.fir ,S P,a <br /> CONDITIONS OF PERMIT: ? < y.: Z CS 0.r2 i <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ;9 � i � <br /> 2. REMOVAL OR CUTTING CF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHOREL AND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. mi g m <br /> I declare that this application(it eluding any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> C <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- , E "a mi m <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- tl ; p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I co 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- i iy, <br /> plication. I agree to permit cour ty officials charged with administering county ordinances or other authorized person to have O o <br /> access to the above described Dremises at any reasonable time for the purpose of inspection. m 3 b <br /> Gl 07Ld <br /> SIGN HERE <br /> (al fur of ow o uilding contractor) I �—^'7daTe)_ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,` o o c c 9 I m <br /> g'o 02ee fA <br /> 0 <br />