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/015c0)'2Sr ,1 it-&4 �r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 0� w <br /> located as shown herein. The undersigned agrees that all work shall be done 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 a <br /> regulations of the State of Wisconsin. <br /> V r Cm <br /> \ OOWNER f�S } VA0rfTELEPHONE '£ <br /> ADDRESS 6()r'© <br /> p <br /> EMERGENCY/FIRE NUMBER (ao J" ROAD NAME C� !1 <br /> LEGAL DESCRIPTION (see tax receipt) SE^T S L ��f S— 3 ro •�- �d if/'- • -IiCJ/ i <br /> Y V_ �u (� <br /> CONTRACTOR <br /> TYPE ERM : DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY X )PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> 0 <br /> 0 2 o N <br /> CTURE/ADDITION USE: {� o � <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z -0 "S <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). �I <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the 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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a O <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an v N <br /> c <br /> PLOT PLAN n 0 as <br /> fn <br /> I N <br /> j <br /> N <br /> O <br /> 7 <br /> O <br /> l7 y <br /> N <br /> Z <br /> CV <br /> D �c �COi rrn, aO � <br /> m <br /> `G 2 a ai 4m <br /> m <br /> CONDITIONS OF PERMIT: a m 3.:i SC g� M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Fzii� - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> O <br /> 1 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- E a m«,; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- it g p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g'$ 00 " <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 t9 permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the abols described premi es at any reasonable ti -for the purpo of inspection. m o m <br /> r E 3 0R- <br /> e) A m : <br /> SIGN HERE <br /> (signature of wrier or building co tractor) (date) <br /> mrdru cam. <br /> ZONING ADMINISTRATOR <br /> lJ; E <br /> «r w �1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N N m <br /> 000000 , Cr <br />