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EV) (6jy , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W -. o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3, <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 5 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m —Z <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. y m <br /> m m <br /> OWNER 'f�/}i/ jlI I y,(,{'1 I LV! TELEPHONE <br /> � t711i j� fl ur.- <br /> ADDRESS �U c p-V(LLe 2D - WWTE SEAR W ; Md _ Ss-12- 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR ( / <br /> \1 <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> r <br /> STRUCTURE/ADDITION USE: o °— <br /> (Home/Cabin;Commercial Business; Bedroom:Deck;etc.) Z ° <br /> 0 0 <br /> a <br /> 3 <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 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 M <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ON ITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o rn <br /> Z n <br /> PLOT PLAN '� 0&)F -/7 �a Ineery//q-k/ 1714/7'1 A _ <br /> y ,I <br /> fn N <br /> CIIeY a �p (cc <br /> O <br /> o <br /> N <br /> m <br /> ire <br /> v <br /> z <br /> I � <br /> f <br /> Dc G+ rcni a� <br /> m $j ' am <br /> m c 9 <br /> D� : <br /> CONDITIONS OF PERMIT: � m : Z CS 00� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c F oi <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ni __N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ni <br /> O G <br /> Er : <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) o: Ml <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ur m«•; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this info 7 g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0 0 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- i `n <br /> plication.I agree to Permit county officials charged with administering county ordinances or other authorized person to have m N <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE �» <br /> (signal re of ow <br /> ne o I n c tort (date) ` <br /> ZONING ADMINISTRATOR J O <br /> a am yraT <br /> TOWN HIP PERMITS MAY BE REQUIRED — N N N m <br /> O0 0 0 N <br />