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p <br /> Bue" .ounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adml�istrator 0 'a' "o <br /> m � c <br /> APPLICATION FOR — LAND USE — PERMITSt i_ E1. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ) m o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirerm ms of the m CO <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 61 <br /> regulations of the State of Wisconsin. o <br /> m m <br /> C J m <br /> OWNER �, / TELEPHONE 0 to �-7 n �' E <br /> 1 0 L <br /> ) <br /> S <br /> ADDRESS, 3 Z7 l& m <br /> / �!nJ 3 m <br /> ' 1d 6 J 7 5 7 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �- <br /> LEGAL DESCRIPTION (see tax receipt) SI I N t S--3 -3 <br /> CONTRACTOR <br /> 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY_X PPRIVYo <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> w <br /> STRUCTURE/ADDITION USE: o <br /> (Home abin;Commercial Business; Bedroom;Deck;etc.) T <br /> P <br /> Z o <br /> Q.- <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 No h (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). o <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be si In and 9 t <br /> 'r <br /> dated by the owner. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. on 3 �- N <br /> c <br /> PLOT PLAN Z� o a <br /> n11 M . o �\ <br /> ai <br /> vo <br /> v� <br /> VA) <br /> I N <br /> 0 <br /> � J <br /> IrJ <br /> m <br /> O y <br /> t/) 2 <br /> 1 <br /> I <br /> I <br /> S '- a� mm <br /> CONDITIONS OF PERMIT: a m�, C g g.e <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. oF SQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - m` 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 41 i Er <br /> c'. <br /> pm <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of ` 5- <br /> PP ( g Y 1 Y Y knowl- o f <br /> edge and belief it is true,comet and complete.1 acknowledge that I am responsible for the detail and accuracy of a I informs- �` «.ro w <br /> XI <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor. i g ' In <br /> O <br /> .tion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> ,or accept all liability which may be a result of the County of Burnett relying on this information I am providing In this ap- i <br /> n.I agree to permit county officials charged with administering county ordinances or other authorized person to have ' p <br /> the above described Promises at any reasonable time for the purpose of inspection. <br /> w i w i <br /> (signature of owner or Du din con t r) Nate)L 114 <br /> ilia n: <br /> € <br /> O il N Nrn <br /> N N N N rn <br /> TOWNSHIP RMITS MAY BE REQUIRED n Orn <br />