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60 / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, 54872 Offim of Zoning Administrator U ' E o <br /> APPLICATION FOR LAND USE — PERMITS — o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 i <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 <br /> regulations Of the State of Wisconsin. — <br /> lQla - x{31 - C4 Q,I s' o <br /> OWNER <br /> � - TELEPHONE a F <br /> m m <br /> ADDRESS )''N"C LLF I 1n1 <br /> b <br /> EMERGENCY/FIRE NUMBERROAD NAME <br /> LEGAL DESCRIPTION (sea tax receipt) l--O T I y Qg-T H-S kFoiZF. 1S LR�1 ��sW Sud 0\�l tS 1 o L <br /> 6vr . L •i- b S �u a wP 3TSN R bt 1 L ) <br /> CONTRACTOR 5£ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING RAG CCESSORY STRUCTURE__)�_ ADDITION p E, <br /> SANITARY PRIVY ILUNG/GRA ING ? ^- <br /> CAMPING UNIT SUBDIVISION 0 o o <br /> STRUCTURE/ADDrrION USE: CG Ae_ VE 5 ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _ <br /> 0 0 <br /> 0 <br /> m <br /> a <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 (V ),septic tank (ST),and drainfleld (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 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISS UED. 7I v m <br /> PLOT PLAN _ <br /> o n <br /> 0 <br /> C I <br /> t q <br /> M <br /> !0.3 R <br /> Mo <br /> FlC]G tt 1 rS o <br /> CONDITIONS OF PERMIT: v g? ' z g g,8 ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e E IR -f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�,,, E m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. QQ G <br /> I 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.1 acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. S R is p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 t 84 $ i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing III this ap- i <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> 9- p <br /> access to the above described promises at any reasonable tint or the purpose of Inspection. <br /> y <br /> mT : <br /> me p <br /> SIGN HERE "a© f w+i <br /> (signature o nor or building cont tor) (date) pq <br /> ZONING ADMINISTRATOR I E i ES F i i <br /> • «N~N «+� Zt <br /> TOWNSHIP PERMITS MAY BE REQUIRED o Iii 41' S5IIR 8 m <br /> 88888888 Umi <br />