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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn 9 z <br /> m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS . —r�,., <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application fora Perms for the work described and is C j <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <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. a m <br /> LA <br /> / 1 ` g o <br /> OWNER -Y17 � ��'✓i:'hO�C? TELEPHON3 -G lq9 _` <br /> ADDRESS /27_?C <br /> Awl,,- k/6F Ile,, A ti <br /> EMERGENCY/FIRE NUMBER �//I ROAD NAME Cl <br /> A C/ ' <br /> LEGAL DESCRIPTION (see tax receipt.f� <br /> I <br /> CONTRACTOR11e4 <br /> TYPE OF PERMIT(S): DWE/LLUNG//BUILDING / GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY 1/1", PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° , <br /> o < <br /> J + <br /> / N <br /> STRUCTURE/ADDITION USE: ZIh 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° _ <br /> m / <br /> a <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 (DIF). <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. O c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o y <br /> PLOT PLAN _ `v <br /> m <br /> S -e C` j�� �> C <br /> M <br /> 1 O <br /> _ J <br /> O I r <br /> J II �J <br /> m <br /> O y <br /> N <br /> i <br /> O <br /> Z <br /> I <br /> f <br /> ' <br /> a � '- a m mMo <br /> CONDITIONS OF PERMIT: a m w. Z C� g' 33 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F O `: Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - —N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ i 9 i In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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 ! m p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m 3 <br /> SIGN HERE <br /> (sig urs of owner o b ildl go Ir to -/(date) <br /> f � E <br /> ZONING ADMINISTRATOR <br /> - ww a+er esa T <br /> P E <br /> TOWNSHIRMITS MAY BE REQUIRED NOV 14 1994 g 8 ;� N g m <br /> 9 ) <br /> I � <br />