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Wrnett County 7110 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o O <br /> APPLICATION FOR — LAND USE — PERMITS <br /> or <br /> TO THE ZONING ADMINISTRATOR:The undersigned Q <br /> rsig hereby makes application for Permit for the work e and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance <br /> dance with the requirements d of the m c <br /> Burnett County Larks Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the lay fs and $ <br /> regulations of the State of Wisconsin. — o <br /> m m <br /> c m <br /> OWNER TELEPHONE n O <br /> ADDRESS d OY'✓1 I H o v-e F-4 le tv1; S y <br /> EMERGENCY/FIRE NUMBER OGp ROADNAME Ut,.n 7_bOVP <br /> O O <br /> LEGAL DESCRIPTION (see tea receipt) 0 <br /> S , I , I,T' T_ ` I p �) I� <br /> W W 6 � <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> V <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> ° <br /> STRUCTUREJADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). n <br /> 2. Show the location of the well (N),septic tank (ST),and drainf laid (DF). V , <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)bL siding yl CLI <br /> measurement to the ordinary high water mark of lake,stream, or river. $G/ <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sign d and 9 <br /> dated by the owner. 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISS ED, 11 3 m <br /> PLOT PLAN z `o <br /> o o- <br /> A <br /> C o <br /> C � <br /> N 1 <br /> 111 V) <br /> ,7 <br /> r <br /> G <br /> N <br /> e <br /> n <br /> O <br /> t <br /> O <br /> � LJ <br /> 0 <br /> O ti <br /> N <br /> �vJ <br /> Z <br /> a <br /> f <br /> >> In In <br /> CONDITIONS OF PERMIT: o m 3.: Z c g 31 <br /> 1. DRIVEWAY MUST MEETDRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. r. <br /> c F 'i ffi =� <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. ' .. . . g m <br /> g <br /> $ � , O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my nowt- <br /> ede and belief it is true,correct and complete.I acknowledge that I am res yinforms - m <br /> q p q responsible for the detail and accuracy of all <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- E S <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing int is ap- <br /> plication. I agr"to permit county officials charged with administering county ordinances or other authorized person to have `: O o <br /> access to the above described premises at any reasonable time for the purpose of inspection. e <br /> m <br /> SIGN HERE <br /> (signature of owner or Id ng ont or) (date) fe <br /> ZONING ADMINISTRATOR <br /> TOWNSHI R ITS M Y BE REQUIRED <br /> m <br /> 98 <br /> E�. ixiKS�8999 tans <br />