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frL cio-y 0 ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A o 0 <br /> 3 IE <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m io <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. 0 <br /> N � <br /> m O <br /> OWNER TELEPHONE n <br /> Ic ASL A14R7 fv o <br /> ADDRESS D 'J L Neo 6--e <br /> EMERGENCY/FIRE NUMBER _ - ROAD NAME - RRD <br /> LEGAL DESCRIPTION (see tax rete pt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/ UILDIN GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° <br /> t J <br /> STRUCTURE/ADDITION USE: C l_ r aP E 0q o <br /> Home/Cabin;CommerclaYBu`smess;Bedroom; Deck;etc.) Z o <br /> 0 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 we II (W), septic tank (ST),and drainfield (DF). r <br /> 0 <br /> 3. Show dimensions infest oft efollowing:(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 submitl ed 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 3 rn <br /> C <br /> PLOT PLAN L LGJIJ,_ /1/(!r o a <br /> m y: <br /> C <br /> O <br /> m U' <br /> I <br /> O � <br /> �OI m <br /> gJ <br /> 1 pt o <br /> Y' N <br /> VV O l_' <br /> J <br /> J <br /> b <br /> ao o <br /> I a <br /> j � r 1f1d/� 7a z <br /> 1 � I <br /> mEyrr 5 R <br /> m —F� J-[ am amy <br /> D--, 9 y <br /> CONDITIONS OF PERMIT: < _': � 1B�' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a �Q � <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C' y^, =ti M <br /> 1 NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 7J: O1 : �c2i a m <br /> I 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,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- h 0 m <br /> tion contained in this application(including any accompanying schedule)and I 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 0' <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 cour ty officials charged with administering county ordinances or other authorized person to have i O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ? 3 $ o <br /> m A N <br /> Al P mi <br /> SIGN HERE ` <br /> 61: N <br /> (all neding contractor) (date) SC? : <br /> o . x <br /> ZONING ADMINISTRATOR g x <br /> TOWNSHIP PERMITS MAY BE REQUIRED o in 9 - m <br /> 000 0 $ s �iN <br /> w <br /> 0 <br />