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M 0�y�- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c 0 m o 0 <br /> F <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work des Abed and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem nts of the M <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. 7V <br /> w r 11 <br /> OWNERTELEPHONE <br /> �1�4By e. S.n N �L arY)caa Y12,J m o <br /> ADDRESS LAI /14 '�" m <br /> EMERGENCY/FIRE NUMBER G/A y:3 ROAD NAME fO�A�S_'/q',d/' j1•-[C!ter <br /> LEGAL DESCRIPTION (see tax receipt) PEI <br /> V^ VG, o <br /> CONTRACTOR P D <br /> I 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE DDfTION p <br /> 2 M <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: 0AR7Z 04 tm El_ <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z 'c <br /> 0 0 <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 (W),septic tank (ST), and drainfield (DF). fr <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,( )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. C 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'II 3 N <br /> PLOT PLAN n o 'a <br /> M � o <br /> C ) <br /> a 9.� <br /> cn <br /> I m <br /> 0 <br /> 0 <br /> n 1 <br /> Cp�c� uwv C� � <br /> o <br /> 1 r� j� InI <br /> *,7Six1;b, <br /> S <br /> A �' nu2g'f m <br /> c <br /> a. DK� 2.O.a & 0 <br /> CONDITIONS OF PERMIT: = < „ ¢ �g 8 <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. =N >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - �' Oi i rn <br /> Lr E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know)- ,o. : � <br /> edge and belief it is true,correct and complete.I seknowletlge that I am responsible for the detail and accuracy of lett informs• g,: t N m N ' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th t this infor- !—E l p <br /> mallon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu ■ permit. I N <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providin in this ap- ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorizedpe n to have - p <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> m e <br /> �a9_ N <br /> SIGN MERE - ' <br /> (sign re f owner o inp contractor) (date) <br /> [ € <br /> ZONING ADMINISTRATOR <br /> a N N MMM Tt <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N g m <br /> �88�8888umi <br />