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07L ('D'2t ' <br /> Burnett County 7010 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <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 3 !1 <br /> regulations of the State of Wisconsin. a m V <br /> m <br /> OWNER L,/Gi YY)e.S �1a�C � � TELEPHONE 66,7- C,C�D._5C'�/ O \ <br /> ADDRESS u rr t[�� <br /> EMERGENCY/FIRE NUMBER ROAD NAME Party Un <br /> LEGAL DESCRIPTION (see tax receipt) C,5n V. Ip- ID , v vl l h 'AVI 1u GGGGIIs w -5—�_� ^ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE __ ADDITION o <br /> n Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 2 0 <br /> o 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 (DF). o <br /> 3. Show dimensions Infeet ofthefollowing:(a)building to all lot lines,(b)bulidingto center line of road,(c)building -1 <br /> measurement to the ordinary high water mark of lake,stream,or river. G <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 y <br /> 1A .Z `v <br /> PLOT PLAN o a <br /> l <br /> M LU <br /> .41 <br /> outhmsc 203 c, ( I <br /> v <br /> 7 N <br /> 0 <br /> 1u i7 Z <br /> a <br /> W IJcY' � m �n�,v�,�nno • <br /> �. n F <br /> m -E� a m m 1 <br /> G o m �cm5''-' • <br /> CONDITIONS OF PERMIT: it.: <br /> _ < m . Lit <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f Em ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <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- «m« <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I "l <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 <br /> access to the above n premises at any reasonaWgIe for the purpose of inspection. <br /> m M <br /> N <br /> SIGN HERE <br /> (Sig atur of owner no contractor) -- '-- <br /> c.... ` <br /> ZONING ADMINISTRATOR - �� 8 ' <br /> ei <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br />