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ON COMPUTER/SCANNED 69004" <br /> " <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c '0o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 <br /> Burnett Count'Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m m <br /> OWNER Vt TELEPHONE mn to��( G1 / /gyp /� <br /> ADDRESS 3 (� ,_ /,/ YP / v1 Q C L, ck 0 0 t e <br /> EMERGENCY/FIRE NUMBER r/`"r 1 1/V/CV%� ROAD NAME e !1 m <br /> LEGAL DESCRIPTION (see tax receipt) / ' .`}. <br /> CONTRACTOR oj-ev� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ARAGE/ACCESSORY STRRUUCTURE ADDITION p \N <br /> n 61 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: ®(G (/'C(�-P o c� <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> S <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 dralnfield (DF). o <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 /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSU . 3 <br /> N <br /> PLOT PLAN A o n <br /> M l 2 W y' <br /> I n <br /> C <br /> If 6Z <br /> 0 <br /> pu5� �a <br /> f� a�� <br /> X30 �I <br /> C Lo+' R a <br /> � om <br /> a <br /> CONDITIONS OF PERMIT: $ w: Q CS 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. G 0 i �� 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - sN' y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ : O m <br /> O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best Of my knowl- O : <br /> i; 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- «ro r. 11 <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- �' p <br /> is <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g $ ; <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.1 agree to permit county officials charged v^administering county ordinances or other authorized peroOn to have o <br /> access to the aW"oscribep premises a ros#nable time for the purpose of Inspection. ' e <br /> m ' i '2 1 a <br /> m <br /> SIGN HERE ` a <br /> (signature <br /> ZONING ADMINISTRATORJUL - $ <br /> T SNIP PERMITS MAY BE REQUIRE ' 9 <br /> o � gm <br /> , , 588888 $8 ami <br /> ul 501)T— ---- ---- <br />