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4)-11 CI '�l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m 3 a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and `L <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 3 "1 <br /> regulations of the State of Wisconsin. m a <br /> c n <br /> OWNERTELEPHONE n <br /> MARUtJ fMDhHt– 115 - 386 - 3��`f m <br /> ADDRESS 947 CTS ?j) . A ljt4D5Dt , 01 ' Sgolb <br /> EMERGENCY/FIRE NUMBER ROAD NAME Co <br /> V" I <br /> LEGAL DESCRIPTION (see tax receipt) Q <br /> — l <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDfTION p <br /> 0 <br /> SANITARY_X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: AA� A q.I I:Y �� ml o <br /> (Home/Cabin; Co mercial Business; Bedroom: Deck,etc.) o o T <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> w <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). i <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building i <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I 3 ur <br /> 11 Z <br /> PLOT PLAN o n <br /> fn , <br /> ATiA�+�E►� m s <br /> t <br /> o ^� <br /> Vic! t = <br /> 0 <br /> 0 <br /> N IY/ <br /> p <br /> N <br /> � P <br /> n <br /> � f <br /> m �c �rDaf m <br /> m 9ff� <br /> 2- <br /> CONDITIONS <br /> CONDITIONS OF PERMIT: < H CS gro <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' : n ?_' p <br /> g <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- d.m M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- . B t I p <br /> mabon 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 a p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 <br /> SIGN HERE `vv"vp`i✓n I n I E ? en: u, <br /> TONING ADMINISTRATOR v <br /> TOWNSHIP PERMITS MAY BE REQUIRED I o N N� m <br /> Lk <br /> - T <br /> 0 <br />