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O1 Cfi'gj <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3" <br /> o � <br /> TO THF ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m p <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. <br /> 0 <br /> regulations of the State of Wisconsin. L',� I y� •a,$ - �� p `" <br /> —� Cn O <br /> OWNERC�XR�y}- TELEPHONE ey�.t�.�� Q�S� ��.� +1 <br /> ADDRESS _ ) h '��� + 'l �.1I <br /> / �.nn�.. tt <br /> EMERGENCY/FIRE NUMBER ROAD NAME�� U G^ rf �p�j �.�.tn.•r'�— �l <br /> LEGAL DESCRIPTION (see tax receipt) P�. l / �� t5 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> n 0 <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o .: <br /> STRUCTURE/ADDITION USE: S�i� �.c{�f.`x CVT'.`'`_—`LLl• � c <br /> (Hom /Cabin;Commercial Business; Bedroom;Deck;etc.) o 'o <br /> 0 <br /> a <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). I ° <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to 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 /> O <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS UST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o N <br /> 1I z <br /> PLOT PLAN s� n Q n. <br /> - m o <br /> m � <br /> ,r J <br /> ►0 7� r <br /> 3 <br /> o <br /> 1Q7— L � <br /> � <br /> � a 0 <br /> S� <br /> o <br /> b <br /> v Q ti <br /> r <br /> r\ Z <br /> � aceMe� of Svcs r� I_ <br /> " Dr aMw�er oivl'�- � <br /> '7rp�J'//YY ( r�IJf'Lr!' ry - g`� a g`m M <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. of � :r' : '{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =(nrr <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : Nm n: rt <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o o C <br /> Mallon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o <br /> further accept all liability which may be a result of the County of Burnell relying on this information I am providing in this ap- y, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> w 0 m <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 0 <br /> m 9 A W : <br /> SIGN HERE <br /> / ��jdh a -� <br /> (si elute of owner or building contractor) .�— <br /> ZONING ADMINISTRATOR _ I t9 <br /> iLNTOWNSHIP PERMITS MAY BE REOUIRE O N U N U C <br /> $ SSS $ $ Su <br />