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ci� . <br /> 3urnett County 7410 Co. Rd. K, No. 10Z Siren, WI 54872 Office of Zoning Administrator w ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descril and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer is of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I iws and g. <br /> - <br /> regulations of the State of Wisconsin. w m <br /> r o <br /> OWNER Ci . is GK E� TELEPHONE $(p(0. 4(S <br /> ADDRESS Zq-7W W � CSS W t • 54*8 q 1S 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> —f3 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION q <br /> A O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION •- <br /> o <. <br /> o - <br /> w <br /> STRUCTURE/ADDITION USE: J o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o v J <br /> p o <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ` G <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 dralnfleld (DF). g <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 all,red and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE UED. 41 a N <br /> Z o <br /> PLOT PLAN o a <br /> C <br /> In U, <br /> 4cfilr,--� <br /> c� I� <br /> 0 <br /> N <br /> o <br /> w <br /> Z <br /> t n <br /> K-* 70 <br /> CONDITIONS OF PERMIT: v Z;: Z c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c 4 Y Z "{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knOwl E o <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of i kit informs- » » m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor. $ $ p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin In this ap- <br /> plication.I ogres to permit county officials charged with administering county ordinances or other authorized ps n to have <br /> access to the above described promises at any reasonable time for the purpose of Inspection. T <br /> '• <br /> � <br /> I <br /> L+ - i <br /> SIGN HERE—)Q <br /> (s gm ture of owner or building mU Qn-- <br /> i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REGUIREWi' �o g p P $ m <br /> OCT2 iI'j 988888;818 am, <br /> '' lJ <br />