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V awAp ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator on m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d ° <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 <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. y m <br /> w � <br /> CC n O <br /> OWNER `..fRW� TELEPHONE <br /> ADDRESS / �)O LI ` V y`f�YYl1Y/ �/�� W�f PiI'" `��/IS/, sl/d/'3 <br /> EMERGENCY/FIRE NUMBER ��01.--' ROAD NAME <br /> /'� WW 1 <br /> LEGAL DESCRIPTION (see tax receipt) P�_ / /� / lei 3 J / (7//Q r✓ - �J/�(J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Li' p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> � I4 <br /> STRUCTURE/ADDITION USE: \tel-Y�FXQ 4 fIJ� ° o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z o <br /> 0 c <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 drainfield (DF). R <br /> 3. Show dimensions in feet of the following:(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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <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 cn <br /> 11 Z o <br /> PLOT PLAN ° n <br /> M o <br /> 67e- �� J Pl t/91e Q <br /> mw <br /> w <br /> Q � <br /> nJc.CQQ c-IiJnJS '3F ���M°� _Q <br /> N <br /> C n <br /> A-t C �A-*o to be �f �e w <br /> N <br /> O <br /> G <br /> P <br /> /,JotR!5be- N <br /> r <br /> 0A — i�� '- a@ °' m m <br /> D-.. � ma _ z <br /> CONDITIONS OF PERMIT: 0 m': Z C8 �O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 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. o L7 n mO <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- : «�m«�; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing it this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m b m <br /> m an° [ <br /> m m <br /> M � O <br /> SIGN HERE <br /> ( Ni <br /> sig r f o or uilding contractor) (date) <br /> o - <br /> ZONING ADMINISTRATOR Q $ <br /> In <br /> TOWNSHIP PERMITS MAY BE REQUIRED po N a <br /> 0000 $ 8 '0 $ (Mn <br />