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) (61) , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> m � C <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 o -�-- <br /> regulations of the State of Wisconsin. N <br /> (� 1 / �n1\ ,'� ,` 1 m o <br /> OWNER llaU�. G VOVILG�N�c TELEPHONE <br /> ADDRESS SK t II W14+'( k 0`�U, (e M'l1 �,/ I y( <br /> EMERGENCY/FIRE NUMBER ROAD NAME IeIIOW {�,C(IT <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> Lm r <br /> STRUCTURE/ADDITION USE: �J`I V <br /> v <br /> (Home/Cabin;Commercial Business; Bedr om; Deck;etc.) . a p <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). ° <br /> 3. Show dimensions infest of thefollowing:(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. Q �1 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 m <br /> c <br /> Z Q <br /> PLOT PLAN Q ° n <br /> N <br /> C <br /> QC ( m C> <br /> QI✓I 1 =1 <br /> 30 <br /> U <br /> w o <br /> o <br /> loo o <br /> r� <br /> Z <br /> I <br /> �— A 8af m <br /> m 9 CS " <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> G m : <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r^ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. `r' m <br /> of E aE O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs r m a; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0 o <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 d cribed premises at any reasonable time for the purpose of inspection. <br /> v <br /> M m A N <br /> / O : <br /> SIGN HERE \y E ' 8 <br /> (signature of owner or building contractor) (date) a' ; <br /> h: o ; <br /> 0 ' <br /> ZONING ADMINISTRATOR <br /> n <br /> TOWNSHIP PERMITS MAY BE REQUIRED N m <br /> 00 o0000N <br />