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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 `m� o + a <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the bQ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. — <br /> m <br /> N � <br /> H <br /> n n O <br /> OWNER I G/ l � L:�j-yr� TELEPHONE 7/� ; G��� �L (,� O E <br /> ADDRESSiS' 1� t„�,i.'7 '-r ti- 1 � � C•7a /� /1gN��ui2� �'('�. $Z30> <br /> h t' <br /> EMERGENCY/FIRE NUMBER y nROAD NAME C <br /> LEGAL DESCRIPTION (see tax receipt)�Alel�.l Sie Yy AN4 SG Cfr'd(1 ' 1"X X/Al O/�r;'1jAA <br /> CONTRACTOR of-) `tel f �/If �J�± CA) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING �(/) GARAGE/ACCESSORY STRUCTURE_ ADDITION ` p <br /> 0 7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> �nl� �y-�.}� -� / o -- <br /> STRUCTURE/ADDITION USE: '-e— <br /> yl 1Of WA �'> c p/7lh 4" 't�u-G/l <br /> ( ome/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 3 <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 dreinfield (DF). <br /> 3. Show dimensions in feet ofthefollowing:(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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a y <br /> PLOT PLAN Z v <br /> 0 0 <br /> C b � <br /> a <br /> c <br /> 0 <br /> '►�soa �J <br /> �reeA pn r o <br /> 110rata OU —� <br /> VE <br /> � z <br /> o � a <br /> P <br /> i <br /> n i m <br /> 0 c�uim <br /> nal ¢m m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e F 0 -Q : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =r» <br /> M: <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �: L7 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ^: <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. w m - m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- `,a' B <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ble 0 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have m N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 0 , <br /> ry m A'410 4 N <br /> a <br /> o : <br /> SIGN HERE <br /> (si a u of own wilding contractor) (date) <br /> ZONING ADMINISTRATOR0[ 7 <br /> OHMMN+Hl9WfH -t <br /> TOWNSHIP KEORMITS MAY BE REQUIREDco N N N N m <br /> 00000000fmA <br />