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Wmett Clunty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn v z <br /> - APPLICATION FOR — LAND USE — PERMITS m _ <br /> f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireff ems of the <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. <br /> w m <br /> OWNERa £ <br /> 916 N AR DSO14 TELEPHONE I,12- 3LIS - 3 <br /> n , <br /> ADDRESS m <br /> Y, 1O2 LAKE-5 JftiN . <br /> EMERGENCY/FIRE NUMBER ROAD NAMEeo <br /> I <br /> LEGAL DESCRIPTION (see tax:receipt) <br /> CONTRACTOR r� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> /� q _ <br /> STRUCTURE/ADDITION USE: �r� q ACH 1 -6 Pet M I L Ailzvch—, o ° <br /> (Home/Cabin;Cilmmerciai Business;Bedroom;Deck;etc.) Z 'o <br /> o � <br /> 0 <br /> 3 <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 drainfieid (D17. <br /> 3. Show dimensions Infest of the following:(a)building to all lot lines,(b)bullding to center line of road,(c)building .4 <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 g Igned and 9 <br /> dated by the owner. 0 i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c y <br /> PLOT PLAN Z c <br /> A o n <br /> � o <br /> C <br /> � r <br /> j7 O <br /> _ 7 <br /> 0 IJ <br /> _ <br /> _ <br /> m <br /> O � <br /> N <br /> n r <br /> G <br /> 70 Z <br /> 1 <br /> o- <br /> f <br /> Rag m <br /> CONDITIONS OF PERMIT: a Z. g <br /> CS m — 11 <br /> I.< . R C S N a Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. - <br /> o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <br /> -3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - c <br /> € ffii � In <br /> 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ol my knowl- E E C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy ofII informs- M <br /> tion contained in this application(including an accompanyingschedule)and I further declare that I recognize the this infor- In <br /> apP ( g Y g ,�' B ': p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ? gr$ $ <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 i i i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ponon to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN MERE <br /> �'Y `✓ m 0 <br /> (date) � « <br /> ZONING ADMINISTRATOR 8 : <br /> 8 <br /> V1 I ii <br /> TOWNSHIP PERMITS MAY BE REOUIRED 0- 0888 <br /> "« «««.`" Mt <br /> 0QQO �'. �, lonr�'}�' m <br /> - 0888 a) <br />