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Burnett Codnty 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Administrator m m� i5' OZ <br /> ° � E <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 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o g �� <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. m <br /> w m <br /> c <br /> OWNER LE ` I I .1 CT- �TEEL�EfPHONE a F <br /> ADDRESS 3� 's I`1 iW o ELK C - RPL,c V A!A M N . 5151 V4 � <br /> EMERGENCY/FIRE NUMBER _52 4&O ROAD NAME 1 77 <br /> i <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY X PPRIVY�\r^FILLING/GRADING CAMPING, UNIT SUBDNIS o <br /> o` <br /> STRUCTURE/ADDITION USE: 7 Pet!Y11 T-/ Itv-ACA I�?ot o .°r- <br /> (Home/Cabin;06mmercial Business;Be om;Deck;etc.) Z <br /> o ° <br /> v <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 (NS) and Indicate North (N). O <br /> 2. Show the location of the well (yi),septic tank (ST),and dralnfield (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. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a y <br /> PLOT PLAN o a <br /> 1 N <br /> �l/ O <br /> CK£1C) m <br /> I <br /> i <br /> N <br /> m <br /> 0 <br /> Ifs <br /> O I� <br /> 4 � <br /> a <br /> 0 <br /> Z <br /> o c m o n g M <br /> m <br /> CONDITIONS OF PERMIT: m 3 : a c a'o ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Yn G7 2 m <br /> PP (including Yaccompanying 1 Y y g` a' <br /> I declare that this application Includin an schedule has been examined b me and to the best of m knowl- o u <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 7i m ': rn <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g u 8 <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 fe <br /> access to the above described promisee at any reasonable time for the purpose of inspection. m <br /> T 380: <br /> m v A o <br /> �_ ? Ill <br /> SIGN HERE V - 8 <br /> (Signal uto of owner o din n` ( _ ,.i• i a <br /> i <br /> ZONING ADMINISTRATOR 8 : <br /> . <br /> TOWNSHI PERMITS MAY BE REQUIRED ( # N tt o o m <br /> �' 8888 rn <br /> 's <br />