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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator I 'a c 0 <br /> APPLICATION FOR — LAND USE — PERMITS . f <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ii ° 00 <br /> 00 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a <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. am <br /> m <br /> o <br /> OWNER Al rk i ROA11AG 1-14Y.*0A TELEPHONE <br /> 4612- lC m �VV-016 7m <br /> ADDRESS OC-2 106 Q do Ckele-- /0010LIA /0w Ik Aj .525-343P m <br /> EMERGENCY/FIRE NUMBER ROAD NAME SrJk� <br /> LEGAL DESCRIPTION (see is r receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_� ADDITION <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 3 <br /> STRUCTURE/ADDITION USE: t➢` S P-'O Z4-4112- o J <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> N <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate Nort i (N). <br /> 2. Show the location of the well (yV),septic tank (ST), and dralnfield (DIF). <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 sli Ined and <br /> dated by the owner. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE UED. 1I a rn <br /> c <br /> PLOT PLAN n o a, <br /> ro S Ps c <br /> M n <br /> Irenlae-e eal fj 3 F <br /> Sfc S - T�o <br /> .f C U - <br /> N <br /> 1N 0 <br /> Pre are alro piorn� l� <br /> J'e4w°1 a'd"i/ ° N <br /> 67W1W 6P1� a�- � o� <br /> i' t'ro r �., 5x6-6-_-es- <br /> 17 I <br /> Sec <br /> ,1 f <br /> Q/ <br /> Trnv�njaaoy <br /> c =. <br /> CONDITIONS OF PERMIT: m .2 '$ g� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Ze <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p a -,-N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V1 f) In <br /> E <br /> E : C <br /> I 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 informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- : $ of p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 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 m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> e N <br /> SIGN HERE ✓" � �lC � E w i E <br /> kie"gin of ownr r Dullding contractor) �c', <br /> ZONING ADMINISTRATOR — J 'S <br /> $ <br /> TOWNSHIP PERMITS MAY BE REOUIRED - 4 O N NO N N N N N" "N T <br /> �II g m <br /> 4 � $ $ $ $$ $ $$ y <br />