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on wp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o <br /> APPLICATION FOR — LAND USE — PERMITS 3. a <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A U4 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. m m <br /> m <br /> OWNER �- \ TELEPHONE <br /> 0 O <br /> 7 C� /`- \a 1`_c A��\ rc�t - Sit(-SIA`l m I <br /> ADDRESS <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME (� <br /> LEGAL DESCRIPTION (see tax receipt) t 0 ' U <br /> CONTRACTOR , ` \ �741_\\ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> n G <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> J <br /> m <br /> STRUCTURE/ADDITION USE: fit'o r�P.a d—Y� !72 yo <br /> (Home/Cabin;Co mercial Business; Bedroom;Ueck;etc.) oZ o <br /> 0 <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 (1317). 0 <br /> 3. Show dimensions in feet of thefollowing:(a) buildingtoall lot lines,(b)building to center lineof road,(c)building 71I <br /> measurement to the ordinary high water mark of lake,stream, or river. Q F <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and N <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMrr CAN BE ISSUED. 1I o N <br /> c <br /> _ 2 0 <br /> o a <br /> PLOT PLAN <br /> L_,Y a vhL C <br /> � - c c <br /> C N <br /> r� <br /> HS <br /> M5 2 <br /> I <br /> z <br /> ) I Ix <br /> I Q <br /> I <br /> r <br /> 1ZOcas7 0 r�. In <br /> �DaOIn <br /> CONDITIONS OF PERMIT: o S.� XQ 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N " <br /> 62 a m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0. i B O <br /> oc <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o ' <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- u y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 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 havei 0N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. -n i , 3 g �, <br /> y <br /> SIGN HERE - •7 <br /> na re of own r r building contractor) (date) TTCC a„ N <br /> ZONING ADMINISTRATOR x E E o <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N m <br /> 0 <br />