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oyle&np <br /> / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � m f c <br /> APPLICATION FOR — LAND USE — PERMITS m 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ibed and w � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme rvts of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. = o <br /> w m <br /> b � <br /> f� C <br /> OWNER -I.J�C�dP t "', TELEPHONE f s✓ '�_ n O <br /> ADDRESS �, w S <br /> m <br /> C, � <br /> EMERGENCY/FIRE NUMBER LI-7 / L, _)_ ROAD NAME y <br /> LEGAL DESCRIPTION (see tax receipt) C, <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION n O <br /> 0 <br /> o <br /> j�lnn y <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z 3 <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). o <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building yl <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 sitned and <br /> dated by the owner. O c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE SUED. 0 y <br /> PLOT PLAN <br /> v n <br /> SPP � r �1Pc�._ <br /> a ;L� <br /> rn ,� <br /> s � <br /> O ILEI <br /> _ <br /> x, <br /> v <br /> O y <br /> w ��II��JJQQ' <br /> J <br /> �l <br /> ��Daf In <br /> CONDITIONS OF PERMIT: IF <br /> :D EL-:� zCB" 8 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m S: �.2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F = : <br /> N: 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. y: � <br /> ' v <br /> � : <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of rny knowl- C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that t is infor- 8 m� 8 m <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> further accept NI liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have ` <br /> access to the above described premises at any reasonable time for the purpose of inspection. g <br /> SIGN HERE <br /> y /!/ m <br /> t ��i.-pil' — '� w � . �' <br /> (s nature owner or litillding contractor) (date) <br /> ZONING ADMINISTRATOR °� Y <br /> E $ i <br /> TOWNSNIP PERMITS MAY BE REQUIREDN N <br /> go« T <br /> o � i4u ne <br /> 88 $ $ 99 In <br />