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07?CA "Y' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v A -. 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3, <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q H <br /> .q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n K7 <br /> 0 <br /> regulations of the State of Wisconsin. �, m <br /> c <br /> OWNER TELEPHONE n O <br /> ADDRESS3;1 '.� 11-1 e.7f uIri7~ 6*b W_ /tea m 1 \J VT t <br /> EMERGENCY/FIRE NUMBER U <br /> /_ ROAD NAME 3 1 <br /> LEGAL DESCRIPTION (see tax receipt) J F11--4 <br /> CONTRACTOR �+oi 7 — <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/A CES O YSTRUCTURE,� DDITION 0 I W <br /> Pdie b«2� <�)p o <br /> SANITARY PRIVY FILLING/GRADING _ CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: 3 C-.riy` r ✓ i <br /> o <br /> (Home/Cab Commer ial Business; Bedroom; Deck;etc.) lOpl¢ Z o <br /> o <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). <br /> 3. Show dimensions In feet of thefollowing:(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. C <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 SUED. 71 a to <br /> 11 z c <br /> J o a <br /> PLOT PLAN ,,�/� �o �a -•h /��' '„ ����- �J y <br /> -_ —>� 111 0 0 <br /> N <br /> Buclr�ia' S ,I /a5 I � <br /> Po I rev i sle l/e� yry� sk% �q N <br /> o <br /> 57, <br /> /!7 N <br /> 0 0, <br /> tr ; <br /> 4 ane <br /> aY/'` 7aoo' <br /> i <br /> 4 _ � Dg� aN ccM <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 i �•Z <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. .'yr' i i n �. m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- o: .x z <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a 1 informs- : h y w: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- i <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1 $� <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- i i <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ; O N v[ <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m m <br /> SIGN HERE <br /> (signatur of owner or buil contractor) (date) NN '^= <br /> p N: <br /> o ; #a : <br /> ZONING ADMINISTRATOR � m .: '� x [ <br /> win en wxx xrh <br /> TOWNSHIP PERMITS MAY BE REQUIRED o O m <br /> 000isRx0 am <br /> et+ <br /> 0 <br />