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&I (Zwv, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U ' o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <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. y m <br /> c <br /> OWNER TELEPHONE <br /> O <br /> 7&GZ.S i L <br /> O m <br /> m <br /> ADDRESS t^y Ssy73Z <br /> 7 i <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> int 4 Lk. DR?, t <br /> LEGAL DESCRIPTION (see tax receipt) <br /> I <br /> CONTRACTOR rr <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p y; <br /> 0 <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> STRUCTURE/ADDITION USE: SAA)I �rjq "-L.) / J (per <br /> 2 l <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o 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). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building -q <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 X <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. T 3 <br /> PLOT PLAN A o J n <br /> m 9� <br /> C J <br /> M <br /> M <br /> I <br /> u <br /> m <br /> 0 <br /> J` <br /> O <br /> J f� <br /> L rel <br /> N <br /> � Z <br /> l y ILS <br /> A rc <br /> A <br /> D c�NrcDi > <br /> n _ <br /> M <br /> CONDITIONS OF PERMIT: a < m c g m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 '2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 62 m <br /> o : S is E ' O <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 C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- amus; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o(2 o <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 mises at any reasonable time for the purpose of inspection. m b m <br /> T 3 <br /> M m A M : <br /> L�I <br /> M N O <br /> SIGN HERE <br /> (sign re of owne ui f c r tor) ` - u <br /> ZONING ADMINISTRATOR - - ): <br /> �� n <br /> TOWN NIP PERMITS MAY BE REQUIRED 9 0 T N N g m <br /> 00 0 0o0 U) <br />