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Bumeft County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,N, m o3. o � <br /> APPLICATION FOR - LAND USE - PERMITS - _ °� <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes 01 _ o <br /> g by application for a Permit for the work described and 'z m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements 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 <br /> w <br /> y7 c <br /> OWNER /< Yah �-� r ��� TELEPHONE o <br /> •! / A �T h m � <br /> ADDRESS ti7' <br /> EMERGENCY/FIRE NUMBER ROAD NAME / <br /> 1 / <br /> -7 p //d�C�r �d` <br /> LEGAL DESCRIPTION (see tax receipt) eC- 17� �-f// ���> : /U/V ����'✓ <br /> 1 <br /> CONTRACTOR , <br /> f I,�' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p b, <br /> oQ <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> / N r <br /> STRUCTURE/ADDITION USE: ( Ct !O%/-�_ o o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 0 <br /> o <br /> pR <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 (W),septic tank (ST), and drainf(eld (DF). a <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 11 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o N <br /> PLOT PLAN Zc <br /> o n <br /> m J0Q m <br /> f' e Cc4 � li z CI c C <br /> M <br /> I I UI <br /> io <br /> kkc z� J � <br /> J o <br /> O y <br /> w <br /> Z <br /> S <br /> g x 98 jm <br /> m aELr'* gna 9 <br /> CONDITIONS OF PERMIT: < Z: zWCg S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Q : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` r" '• b g ' 1 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B 8 p <br /> Mellon I am providing will be retied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. $ <br /> SIGN HERE <br /> (signat64 of owner r bulldi g c nt r) I -- <br /> ZONING ADMINISTRATORyl U <br /> TOWNSNI EMITS MAY BE REQUIREDL to �i 9 in ;8 m <br /> 89 8888 in <br />