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cc�-rLp <br /> Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 0 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and mc <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the w <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. m <br /> w � <br /> c <br /> w O <br /> OWNER I/fit .n/lt TELEPHONE �-3S_ -770 <br /> \ . � w <br /> ADDRESS 61�0l),egtyV PROS <br /> EMERGENCY/FIRE NUMBER V-2-/-74 ROAD NAME //! l� <br /> LEGAL DESCRIPTION (see tax receipt) �f � ('nod L2 Lof Z_ �3G 7t`p Al .2'IPW <br /> / t <br /> CONTRACTOR Ac £ C�C.o�1�}7<ry✓ I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_Y_ GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O <br /> SANITARY_ PRIVY FILLING/GRADING MPING UNIT SUBDIVISION <br /> o _ <br /> g,JD 3 <br /> STRUCTURE/ADDITION USE: � o <br /> Hoabin;CorrWnercial Busine s e room eck;etc.) Z <br /> o ° <br /> 9 <br /> N <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). 1 <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 o <br /> measurement to the ordinary high water mark of lake, stream, or river. C 1 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 m 1_ <br /> dated by the owner. o <br /> 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a `1 rn <br /> 71 Z `v <br /> PLOT PLAN ° n <br /> m o <br /> I �• <br /> N <br /> A <br /> y •n <br /> N IGI <br /> O ly`r'es <br /> J <br /> 71 <br /> J <br /> b <br /> 1 <br /> W <br /> 3 <br /> D S w <br /> CONDITIONS OF PERMIT: `R c:8 .0 m i <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. z m'o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o F r+ T�' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n m <br /> i a IF I ,C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know[- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a w «r <br /> L7 � <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor `� B o p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 j o o <br /> further accept all liability which may be a result of the Count of Burnett relying on this information I am providing to this a <br /> P Y Y Y Y 9 P 9� P� <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 apove described pre es at any reasonable time for the purpose of inspection. w b w <br /> a A <br /> m A . <br /> SIGN HERE 17 43 <br /> eq,: b' <br /> ( ip atu a of a <br /> &ner or buitdi ontr 0 <br /> ZONING ADMINISTRATOR ' - - - - �_-' <br /> 8 . <br /> TOWNSHIP P RMITS MAY BE REQUIRED j Q o N 8 m <br /> SEP � 3 soo o $ SM <br />