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0�? cm�o- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the q <br /> Burnett County Land Use Ordinance,Sanitation Code, and with allo/tFJte�r applicable Co my ordinance's/and the laws and 3. n J <br /> regulations of the State of Wisconsin. C7/�q� � r t a f�I�R� S SAN y w d <br /> OOVI m� <br /> 7 TELEPHONEC n f <br /> OWNER �— o � <br /> I 55 I + m m <br /> ADDRESS <br /> l <br /> EMERGENCY/FIRE NUMBER /�I ( ROAD NAME <br /> LEGAL DESCRIPTION (see tex receipt) UW V4 SE; l V l S 0 _r II 0' 1 R T <br /> CaOC . �� + csmv. fa <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n (J <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> l o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> a <br /> m <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). o <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. <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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '" o N <br /> c <br /> PLOT PLAN n o a <br /> M 0 <br /> 0 <br /> C <br /> a <br /> M <br /> G In <br /> a3 ay& _ C>6 <br /> 130t 0 I f <br /> — Ll — - o 0 <br /> 90 E4 <br /> s / N <br /> f N , <br /> J__ <br /> m <br /> uw Ncw nr/q.f <br /> 0-- <br /> N <br /> LN (5 <br /> M z <br /> ,sv <br /> i I <br /> / <br /> m c -Wrcni aO -0 <br /> N 71 ff2. a a m <br /> CONDITIONS OF PERMIT: a ,z <br /> CS .0 5' i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAY OF PERMIT ISSUANCE. a £ <br /> Sii Q : 1 <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. o O o � mm <br /> 0a: <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- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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. I a'$ <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 V" i i O N o j� <br /> access to the above described premises at any re onable time for the purpose of inspection. j E : m o t(0� :' <br /> 3 0 N O <br /> m m <br /> SIGN HERE a <br /> (signowner or b contractor) <br /> ZONING ADMINISTRATOR z!l/yZGC� i MAAUGE <br /> TOWNSHIP PERMI MAY BE REOUIRED ' 7 0 0 0 o $ B y <br /> 0 0 0 0 <br /> an <br /> F- <br /> _-.__- <br /> 0 <br />