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eo-0y", <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS i 3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. - <br /> m m <br /> c eJ O <br /> OWNER r[l C' 1nI �1l TELEPHONE -2 C1 <br /> I (( cc // (� f m <br /> ADDRESS ZSR l�l,Qc7 S S�� `ls�- I A-ul Mn. 5-5/o <br /> EMERGENCY/FIRE NUMBER f ROAD NAME /�) <br /> LEGAL DESCRIPTION (see tax receipt) N}�I , f yy1n�Q /�7� Ln <br /> CONTRACTOR �rL tC J2 }�/ r lCCoef <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE I--- ADDITION p <br /> n L7 <br /> SANITARY PRIVYFILLING/GRADING f CAMPING UNIT SUBDIVISION a ° <br /> STRUCTURE/ADDITION USE: S V h 4- OYV\ <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <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). I o <br /> 3. Show dimensions infeet of thefollowing:(a) buildingto all lot lines,(b)buildingto 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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. anan <br /> a w <br /> PLOT PLAN 0 Q <br /> S y�L <br /> A-4 c m 0Fi <br /> R1 <br /> N <br /> I m <br /> n <br /> 0 <br /> IJ <br /> N l� <br /> 0 1 ryl <br /> J <br /> J <br /> l7 � <br /> I <br /> I z <br /> G <br /> MM O_ C-0W rDD0 -0 <br /> '0°. D&� day am 9 <br /> CONDITIONS OF PERMIT: H': Q Cg 0 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o� : -4 <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o J �'�-rn I M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' .'ten : O = m <br /> g nLri C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> ai ' m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m'"i T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- ig g p <br /> motion 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 ? O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 bo 9- <br /> A : <br /> ///LC, M N <br /> 0 : <br /> e <br /> SIGN HERE 1-/�Z <br /> (sig to of owne building contractor) <br /> ZONING ADMINISTRATOR �? Z;` � <br /> - ( mNNN N N NO$ $ $ $ $ $ $ $TOWNSHIP PERMITS MAY BE REOUIRED <br />