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Bumett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator Me -1 z <br /> Me m o 0 <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 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ((//gy�m c U l <br /> Burnett County Land Use Ordinance, Sa Ration Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. 'O /l/,�_l ] o <br /> eco C�. no' S• Chf-i- VicA' pm <br /> CO <br /> � m <br /> FOWNER TELEPHONE a <br /> ADDRESS< 4 �O Cir( t'/ICS MA) S OI m m <br /> EMERGENCY/FIRE NUMBER ROAD NAME '{ <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) --S' <br /> CONTRACTOR I' 1 <br /> JJ ) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 11 GARAGE/ACCESSORY STRUCTURE ADDITION � <br /> 0 <br /> SANITARY PRIVY FI LING/GRADING CAMPING UNIT SUBDIVISION oo` <br /> o <br /> I <br /> STRUCTURE/ADDITION USE VSnm 0 <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> rb o <br /> 1^ D <br /> y' <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). o <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 4 v y <br /> PLOT PLAN z <br /> o n <br /> m �= <br /> I ) <br /> b <br /> 0 <br /> o <br /> m 0i <br /> o <br /> Q <br /> 1�5 1///���J/ �l a C k <br /> /O �! Ta- J 7:� D N (n 1, W D D F � <br /> m a m a <br /> CONDITIONS OF PERMIT: <br /> 1. URi'Vt�NAV MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS nv oFi¢SUANr�. Z f0 o ? `� z <br /> OR NG OF TREES AND VEG ��"- o F T w ! M <br /> CUTTING 2. REMOVAL ,rVATD IS�STRICTED ALONG SHORELINE. ' = m <br /> TZ 2 <br /> 3. NO GRADING OR ;,HOR`' AND. Al. ATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> g : <br /> c <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of myknowl- <br /> o I m G) m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. I $,� u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ a 8 <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 CA4, vi p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE <br /> (sign re own r ding contractor) E <br /> LI <br /> ZONING ADMINISTRATOR - -------- ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED SEP — Z 1992 <br /> N N N O <br /> 888 S <br />