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Bumett CdI�nty 7410 Co. Rd. K, No. 102, Siron, WI 54872 Office of Zoning Administrator 0m c 0 <br /> APPLICATION FOR — LAND USE — PERMITS �_ £ <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes Q = ` <br /> 9 by 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 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the aws and (� <br /> regulations of the State of Wisconsin. o <br /> a � <br /> c <br /> OWNER7,4M� �r TELEPHONE 'J)rj_ � 302-_ A2 a vgE <br /> ADDRESS 2Cx-�4 V1Ae C ltJ -A%.rz <br /> EMERGENCY/FIRE NUMBER ) 4G <br /> ROAD NAME S . ^_ "� e CSO 'n �. LA W <br /> Pe.RG� \\ t 60 ooD©T.�� T W <br /> LEGAL DESCRIPTION (see tax receipt) Q 1C)ow O r, � C'+OV m <br /> CONTRACTOR O 'r <br /> 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING '51" _ GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o S <br /> o <br /> tiJ y r <br /> STRUCTURE/ADDITION USE: a o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> 0 o <br /> o v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) �� N <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). rpm <br /> 3. Showdimensions Infest ofthefollowing:(a) buildingto 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. X <br /> 0 tJ <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and 9 <br /> dated by the owner. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 11 9 rn <br /> Z c <br /> PLOT PLAN 09 <br /> M o <br /> C <br /> /\ 1 �s I o <br /> CU STSuCJSe SPSJ;C. ,C �( M <br /> s <br /> l pp <br /> CI- <br /> s- <br /> / J <br /> _ v► <br /> `i <br /> j R0 In <br /> CONDITIONS OF PERMIT: 3.? ,z C 0 g $ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. j o Fi 18 � - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - —N XI <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. `' �: O i O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl. <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of at ...forma- «.m a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that I his infor- IS a G <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I1 ; g`$ 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing i this <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have 0i p <br /> access to the above described premises at any reasonable time for the purpose of inspection. In <br /> e i <br /> m 8 ` <br /> m <br /> SIGN HERE - ` p <br /> (signature of owneror b it ng contractor) <br /> ZONING ADMINISTRATORJUN/ - <br /> ., ' <br /> II <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> (T <br /> ONINn `O'NNtNn8 m <br /> 88888888rmn <br />