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Bums" Count 7410 Co. Rd. K No. 102, <br /> Siren, wi 511872 Office of Zoning Adn�jinititator � <br /> Y <br /> TO THE ZONING ADMINISTRATOR: <br /> FOR herebymakesapplication orPERM«TS work described and , k <br /> a Permit m a , <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 $ <br /> regulations of the State Of Wisconsin. <br /> u )' <br /> OWNER TELEPHONE e O <br /> ADDRESS <br /> /60 L,_ 1u <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Z. <br /> ro w i <br /> CONTRACTOR <br /> r� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION f� <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION o <br /> o c <br /> o — <br /> STRUCTURE/ADDITION USE: `" r <br /> o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) v <br /> 2 0 <br /> o v <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 dralnfield (DF). o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,( )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 igned and 0 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE C <br /> A PERMIT CAN BE SSUED. 0 v <br /> PLOT PLAN <br /> I:: <br /> b �-� a o <br /> m, <br /> AJ 13 f' y <br /> I R <br /> 0 L) <br /> 0 <br /> 4 � ~ <br /> A` <br /> y0 V Z) <br /> I� <br /> 40 <br /> FT W <br /> f <br /> CONDITIONS OF PERMIT: _ `l' on- -' m °� R4 3.n T <br /> v c_'3 <br /> 8" <br /> "' 1—CET <br /> 1. DRIVEWAY MUST MEDRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E IQ � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L4`E Gas m <br /> I declare that this application(including an accompanyingschedule has been examined by me and to the best of y knowl- <br /> aP0 (� fl Y 1 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- '` « «:' <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing n this ap- <br /> 88plication.I agree to Permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> r mT AQP` <br /> SIGN HERE « '" <br /> (sip t roof owner or building contractor) (tlats) ' « '• <br /> ZONING ADMINISTRATOR <br /> . . 8E <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> s 4X (� iS ES <br /> $ 88 $88 $$ ai <br />