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`�1 cny/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS — <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and N �h <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 C-'>. <br /> regulations of the State of Wisconsin. w m <br /> m <br /> y�f �/f \ n O <br /> OWNER O N 7l •/ Q tl--YtZZAyL 0., J TELEPHONE C�,f <br /> ADDRESS �1 ed-y, // r X/�KLrS� ,44,Yr 5-5-0TI -7 �!1, <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> _Q <br /> LEGAL DESCRIPTION (see tax receipt) <br /> k.{ <br /> CONTRACTOR 012�� ^N C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY ✓/FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> J - <br /> STRUCTURE/ADDITION USE: ° g <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 0 o <br /> O 9 <br /> N <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 /> r <br /> 2. Show the location of the well (VV),septic tank (ST), and drainfleid (DF). 2 <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. 0 7 - <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X 1 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o N <br /> C <br /> _ ZQ <br /> PLOT PLAN L i L 0 413 <br /> M n l <br /> 0 <br /> ICA I <br /> M <br /> 0 <br /> O <br /> J I{17� <br /> 144, <br /> J <br /> m <br /> O \. <br /> � Iti <br /> I <br /> M iiy ��I1r DD <br /> 8 9 m <br /> J �1 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS IN 60 DAYS OF PERMIT ISSUANCE. Z e o <br /> O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — <br /> a: <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rqQ C <br /> E : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- �E O <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 I further declare that I recognize that this infor- i i <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $'$ <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- �„ " <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the abov scribed Dr misee at any re n e time for the purpose of inspection. T v g <br /> m ; <br /> SIGN HERE <br /> (slgnawner or building contractor) (date) <br /> ZONING AD (NIST OR � '�" ` g [ K x f <br /> TOWNSHIP PERMITS MAY BE REQUIRED o . N N m <br /> 0o �8� f3 $ vmi <br /> ll N <br /> O <br />