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e& ay)w <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 ; o <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c ` <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and $ rQ —� <br /> regulations of the State of Wisconsin. m `4 <br /> *•tom `'p c o <br /> OWNER ' 1QAA c� �L�/ S•ye / TELEPHONE 3 (fp_ � 870 - o £ <br /> v o � <br /> ADDRESS ';L 97 w I dam �d <br /> EMERGENCY/FIRE NUMBER 9,2427 ROAD NAME We. Ida I-u-- <br /> I <br /> LEGAL DESCRIPTION (seetaxreceipt) u N9A— Sr T-36�y- R— n L(/ Z�) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo` o <br /> 1 1 � <br /> STRUCTURE/ADDITION USE: Os-cr P in— 14 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> ° C <br /> m <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). 00 <br /> 2. Show the location of the well (W),septic tank(ST),and drainfield (DF). 14, <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. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be: and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STARED FOR ONSITE VERIFICATION BEFORE A PERMrT CAN BE ISSUED. it o y <br /> z o <br /> PLOT PLAN ° n <br /> O < <br /> M � o <br /> C ' <br /> 1 s <br /> 4. <br /> m <br /> 1 <br /> o <br /> o <br /> O <br /> o I� <br /> m <br /> QJ <br /> O ti <br /> a <br /> Z <br /> N r <br /> RsoZ <br /> CONDITIONS OF PERMIT: o ' 'R 8 8 ?C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. '• Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r rej ` i C <br /> i E C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl. <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all inform&• In , �i�' rr <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Infor• ^,4k <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&UthOrIZed person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> i <br /> w <br /> SIGN HERE <br /> (signature of owner or ruilding contractor) (date) <br /> •r�c�rY_V,t lywwtJ1 �` E <br /> ZONING ADMINISTRATOR ` 8 '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 88 88,88 u <br />