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� I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m a o <br /> APPLICATION FOR — LAND USE — PERMITSa8 2i( 3 <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 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ n <br /> regulations of the State of Wisconsin. H m <br /> w v <br /> OWNER P4 tir /./,C'13 TELEPHONE v ��' yd� �3lJ� o F <br /> ADDRESS /O(�(� q CpoiY ��-�/yS /q//Y/y m <br /> EMERGENCY/FIRE NUMBER '7}�L� ROAD NAME �ry C�Oy i/ /_/LM� 3 t IJ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONQj <br /> p <br /> G1 <br /> SANITARY PRIW F LING/GRADING CAMPING UNIT SUBDIVISION <br /> o < <br /> w r <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> a o <br /> 0 <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). I 5 <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. <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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLAN � o n <br /> p <br /> M y_ <br /> VAULT fRIVV L-A KG � °co <br /> 0 <br /> I <br /> JIL o <br /> 0 N <br /> n <br /> O O <br /> _ <br /> TRI vy <br /> w <br /> ku <br /> IS <br /> d <br /> i <br /> D N N r D D p <br /> o c = -. a F mmu <br /> m_ D � � am 2. 9 <br /> CONDITIONS OF PERMIT m < C o ic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m n OC <br /> $ c : <br /> a � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ m 8 <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 <br /> access to the above described premise t any reasonable time for the purpose of inspection. 3 $ `� <br /> m ^ <br /> m E i i i <br /> N A w <br /> 8i <br /> SIGN HERE <br /> (signature of owner or bui tp 1 j te) o , s <br /> ZONING ADMINISTRATOR Al 1 5 1992 $ <br /> TOWNSH PERMITS MAYBE REQUIRED H N`8 8 m <br /> 9 r <br /> ... ut . vt ut o o . <br /> 88 8888N <br />