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n'7aWLe, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'oo 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> m 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 m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. m° <br /> m � <br /> c <br /> OWNER TELEPHONE n O <br /> dKiE.tj o <br /> f p \` � <br /> ADDRESS 2�'� Q¢Qn� III (il ��� I'til1 S �� <br /> EMERGENCY/FIRE NUM`-BER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 �CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p 7 <br /> iU <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 1 �yI / <br /> STRUCTURE/ADDITION USE: �,��I LI VI 4 �l�t 1--C70, °— <br /> (Home/Cabin; mercial Business; Bedroom; eck;etc.) = o <br /> o a <br /> ! j <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). <br /> 2. Show the location of the well (Vi), septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto 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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> c <br /> _ Z Q <br /> PLOT PLAN � 0 n <br /> m o <br /> C , <br /> 6 19 <br /> I <br /> , N <br /> I <br /> O U <br /> i <br /> D <br /> I` <br /> A so w r>n0 a <br /> m —E. '2 amem33 <br /> 33 6 w <br /> CONDITIONS OF PERMIT: ^ Q 8 ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N ' L7 n m <br /> $� ' C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o o::i : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- .+y : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B0' <br /> ; G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o`$ $ <br /> further accept all liability which maybe 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 ON o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 0 <br /> m A N <br /> _ m 88p <br /> SIGN HERE w $ <br /> (signal wner_or building contractor) i (��.. (date) <br /> re of o ? Fr . <br /> ZONING ADMINISTRATOR �jIm 8 : <br /> www m <br /> TOWNSHIP PERMITS MAY BE REDO 1 61 o N N N a N m <br /> M <br /> oogo, 0 o r/1 <br /> V \ ; %o <br /> u <br />