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ba t4' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54472 Office of Zoning Administrator w 8 c c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The u <br /> rWersigned hereby makes application for a Permit for the work descri and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the m c <br /> Burnett Courtly Lard Use Ordinance,Sanitation Code,and with all other applicable Courtly Ordinances and the I and <br /> regulations of the State of Wisconsin. �, m <br /> u iD <br /> C <br /> OWNER .S-It-ve + 7->°tPS,0. TELEPHONE 7/5_ _7po <br /> o <br /> ADDRESS//OS �S C �f 7J P e <br /> EMERGENCY/FIRE NUMBER /�w ROAD NAME S�l/�SS C <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION ] <br /> a <br /> n L7 S <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> � <br /> II w <br /> STRUCTURE/ADDITION USE: / rL xe.*v q/'P't o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <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(NS) and indicate North (N). <br /> 2. Show the location of the well (1N),septic tank(ST),and drainfleld (DF). <br /> 3. Show dimensions in feet ofthe 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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be al ned and 9 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STATED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED v N <br /> PLOT PLAN Ji / o S <br /> Ire <br /> f looms e - y <br /> e111 � 36Xvv = 7 I G) <br /> _ <br /> � I � <br /> �* m <br /> m <br /> CONDITIONS OF PERMIT: ? m Z, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E 77 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED.' '• QQ p <br /> application(including Y accompanying 1 Y y ` r C <br /> I declare that this licalion Ineludin an aceom in schedule has been examined b me and to the best of 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 /> lion 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 ik permit. I $ $ <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 pe n to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o g 51N 8 m <br /> 8888888'8 MW <br />