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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m f o <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 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. w m <br /> E m <br /> Q / n IE <br /> O <br /> OWNER �� `z 4� /� �L� TELEPHONE <br /> - m <br /> ADDRESS w\ <br /> �R � ROAD NAME <br /> $toss L�,�e Ed / I <br /> EMERGENCY/FIRE NUMBER <br /> LEGAL DESCRIPTION (see tax receipt) Lo� 10 5 t LA Al <br /> CONTRACTOR ��'� 5 O J <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREDE ADDITION O <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> T /y/ _ <br /> STRUCTURE/ADDRION USE: <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o d <br /> a <br /> m <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 draiMleld (DF). °r <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building q <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <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. c o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o N <br /> 7I Z `v <br /> PLOTPLAN <sj i� GCt� E.cvt< s� � o a <br /> laf <br /> 4 A Rted h 1 J '1 t N <br /> imoz \"S'AJ <br /> ri Ato -It 9L) <br /> n'p O <br /> v, ( ^ <br /> E rs� \4' S e <br /> `to,y = <br /> rn��urP� n <br /> 1)?ccCcor __ <br /> _ <br /> m <br /> v <br /> �uto z <br /> D p <br /> \- ~\ °Q °� o nF m <br /> a _. m M <br /> CONDITIONS OF PERMIT: < 20- Q w o no m= 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- 0 io o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- :. '� : °: O <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- u <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 a g <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 1� <br /> access to the above described premises at any reasonable time for the purpose of Inspection. - ' • o <br /> NT 0 A <br /> SIGN HERE <br /> It (sip roof owner o I] ng contractor) (date) <br /> 8 i x i i <br /> ZONING ADMINISTRATOR ` '• <br /> mTOWNSHIP PERMITS MAY BE REOUIRED u, N p, 5A oOi <br /> m$ 888888y <br />