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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admini#trator co m of o <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremery s of the $ <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m n <br /> a r <br /> o <br /> OWNER TELEPHONE �! £ <br /> ADDRESS 61301 /i2/hHplN C-G�e e (� <br /> 9— <br /> EMERGENCY/FIRE <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> / 7iw. <br /> LEGAL DESCRIPTION (see tax receipt) G(J /00/ E �S6 L �j-ry rL k <br /> CONTRACTOR WWrP lake- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURESYTQS ADDITION 0 <br /> o �' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: ° o y <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> 0 o <br /> 0 c <br /> � 1 ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I t7 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). y� <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (D17. <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road, (c)building 4 <br /> measurement to the ordinary high water mark of lake,stream, or river. 0 <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be si ned and 2 <br /> dated by the owner. 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 11 o m <br /> 11 z cv <br /> PLOT PLAN A o a <br /> m o <br /> f: � <br /> N s <br /> co,cw le 46/a,-/- <br /> a <br /> 4 <br /> f•f s xL <br /> 0 <br /> 38t CK, S Pe S jkv11e / m <br /> r,,-so,, G,,-e4t a <br /> U MAX- U d" Y�f <br /> 2. <br /> will <br /> P_rcc�u �J -F L��..t'�ti{ r%rvsco _ . , — m. 2L a m a <br /> ce, L.� r E•v.M1`.. P'��`'"- n-` o $ <br /> CONDITIONS OF PERMIT: J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e f �Q ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N' <br /> N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o' ' E ' m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o 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 Ill informsm <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize the this infor- d p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized per on to have ? O: p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. ro e <br /> m <br /> SIGN HERE <br /> ( lu of owner r building contractor) (date) <br /> i <br /> ZONING ADMINISTRATOR <br /> ««�qq« «� m <br /> TOWNSHIP PERMITS MAY BE REQUIRED itAN O Nn N <br /> 8888888 U) <br />