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Mu <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator �in C ,Z <br /> d R O d <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and '2 <br /> located as shown herein. The undersigned agrees that all work shall be clone in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3. "�- <br /> regulations of the State of Wisconsin. o I O <br /> w � 1 <br /> OWNER M% ffD4W Mp 2/ Hi TELEPHONE 12 , 12Q Q <br /> ADDRESS_SgDD VE:koo l W. APT- .x.[71 Epi MA Mnl_ 2' ++36 � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 0 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> STRUCTURE/ADDITION USE: C) <br /> (Home/Cabin;Com ercial Business;Bedroom:Deck;etc.) Zc <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 01 7- <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 (DF). o <br /> 3. Show dimensions infeet ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building T <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 a <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v N <br /> Mill <br /> c <br /> PLOT PIAN o n <br /> �.y�-� �lti� rn <br /> 1'tillTL#�� c It <br /> C� <br /> I <br /> Oce <br /> _ o <br /> N <br /> O <br /> J <br /> J <br /> b <br /> C7 � <br /> N <br /> 2 <br /> rn1�v1�ryy11 <br /> I <br /> G <br /> g - in�� N$$ fm <br /> m g� 2a$ Qm <br /> CONDITIONS OF PERMIT: m y:: Q CS 0'5 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a 9Q -1 <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. ' N m <br /> C <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- a m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. B p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 , o� o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m o m <br /> ` v A 0 <br /> 3 <br /> I- Z Po <br /> SIGN HERE ' <br /> 8 i <br /> (signal re of owner or building con oq Xry (da E ' <br /> U o <br /> ZONING ADMINISTRATOR )` <br /> TOWNSHIP PERMIT MAY BE REQUIRED <br /> roo <br /> aT� <br /> o 0 0 U)) <br />