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(Jr � I <br /> _.County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> f0 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and S <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 Ordina ice,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 0 <br /> regulations of the State of Wiscor isin. N m <br /> ww~. <br /> mn n 1 O <br /> OWNER TELEPHONE I rY�1 _ <br /> ADDRESS (A as o ll <br /> EMERGENCY/FIRE NUMBER ROAD NAME d <br /> l � C <br /> LEGAL DESCRIPTION (see tax rece pt) <br /> CONTRACTO R o - T <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> Q <br /> SANITARY PRIVY0 <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o 1\u <br /> • <br /> STRUCTURE/ADDITION USE: r <br /> Home/Cabin(Commercialbusiness; Bedroom;Deck;etc.) = o <br /> % ) <br /> a <br /> SIJ 1 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size f all existing buildings (EB) and all new buildings (NS) and indicate North (N). <br /> 2. Show the location of thew II (W),septic tank (ST), and drainfield (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 ordinaryhigh water mark of lake,stream, or river. 0 P <br /> 4. If separate plans are submi ed by an architect,engineer,builder,contractor,etc.,the plans must lb signed and <br /> dated by the owner. p o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 rn <br /> PLOT PLAN A o n <br /> dee at LIA4 c � <br /> nai _ (� = <br /> S �n�a� © l�K�- S'� • <br /> C <br /> � s <br /> n <br /> 0 <br /> O <br /> 0 1 <br /> J <br /> o y <br /> N <br /> y <br /> � 1 <br /> S�a� Gt-✓T VP-rr�Gc��7/o'er O�� '1���� <br /> l ermi't l Ia7� <br /> N DD O <br /> yg� 2am 0 <br /> CONDITIONS OF PERMIT: <,Z': Z C8 O m �+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N 9 <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. . . . 0 p <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i «�m m <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- �? B p <br /> malion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 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 person to have ro <br /> access to the above described 3remisers at any reasonable time for the purpose of inspection. m u, <br /> :' 300E <br /> m - m A w : <br /> SIGN HERE <br /> (a' natu of owner or Inq contractor) (date) �? <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIREO m <br /> 080 8 8w <br /> 0 <br />