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eri cinyvl <br /> aurnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N m o <br /> APPLICATION FOR — LAND USE — PERMITS — <br />'O THE ZONING ADMINISTRATOR:The undersigned here makes - = <br /> g by application for a Permit for the work described and 'Z w <br /> xated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements ol the M <br /> lurnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> 3gulations of the State of Wisconsin.OuN 15 - <br /> iWNER CLIFFORD RDTELEPHONE %6' 439 <br /> IV <br /> DDRESS 3`b 3 A i-D EK. ST 1j. S`f$q3 m <br /> MERGENCY/FIRE NUMBER ROAD NAME <br /> EGAL DESCRIPTION (see tax receipt) <br /> c <br />:ONTRACTOR <br /> YPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 rn <br /> ANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o_ 1 <br /> 0 <br /> _ <br /> N <br /> TRUCTURE/ADDITION USE: (L G <br /> (Home/Cabin;Commerci6i Business;Bedroom; Deck;etc.) J Z <br /> oO <br /> \y 3 <br />)IRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) VU " <br /> Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br />!. Show the location of the well (VV),septic tank (ST),and drainfield (DF). <br /> I. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)bull Jing <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> I. if separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. O a <br /> DOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a y <br /> c <br />)LOT PLAN A o 0 <br /> rn y_ <br /> C (� <br /> t <br /> oon <br /> P _ <br /> o <br /> _ <br /> O y <br /> N <br /> Z \( 11 <br /> I <br /> T'TT DF m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 �'R <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - rgn M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O1 O m <br /> X : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my kowl <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs 61 m`^ T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this nfor- 8 Bp <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a pe it. 1 819 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in th a ap- ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ? O <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 <br /> r., - a <br /> N <br /> SIGHERE ' ' �.. w a <br /> (date) <br /> 1p� i � o ? <br /> ZONING ADMINISTRATOR ! . 8 i E <br /> MITS MAY DE REQUIRED U <br /> ((�",-I, <br /> M �NNae'' T1 <br /> TOWNSHIP P 'i' — _ w <br /> N N 5n'N m <br /> 8988888 <br />