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Barnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m a oo_ <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. p m_ <br /> m m <br /> /J c O <br /> OWNER <br /> /11G7r Y; n 5cAczelCY TELEPHONE <br /> ADDRESS /1-/- 1 c2 X ��i5�e`l Lake W/ 2/8 I/ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) -�" <br /> G IU <br /> CONTRACTOR �or m� <br /> 1rheC Veks) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o V <br /> n O <br /> SANITARY PRIVY J//F�I�LLING/GRADING CAMPING UNIT_ SUBDIVISION o °< <br /> / / i �f m r <br /> ry <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o -}-- <br /> 9 <br /> m � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 1 <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 (MI),septic tank (ST), and dralnfield (DF), g <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 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a w <br /> 71 Z v <br /> PLOT PLAN <br /> M o <br /> CI <br /> f LS f6 b e <br /> C.et rape r �,` �i a>� s, <br /> m <br /> 3 U N�fi i s -ta �-r- <br /> ��� �� �rwu <br /> adv- <br /> J� I� <br /> m. Dn•� ? 'am ami <br /> 11 tow <br /> m' <br /> CONDITIONS OF PERMIT: ^ � gZ C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z * <br /> o o Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o £ ' E = i f a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` In' ': O ' m <br /> m c i C <br /> o , <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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 informs- m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- S rn? p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. '• g m 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. `p� <br /> y/� T 8x: <br /> SIGN HERE � ✓�''� <br /> m i <br /> (sig Offoo�w�n/J��r bu ding contractor) <br /> ZONING ADMINISTRATOR " IE k�3 T PP.,- <br /> M: T <br /> TOWNSHIP PERMITS MAY BE REQUIRED L"SA kv' . 6o m <br /> $ 88 8 88UM) <br /> I <br />