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04 Gf1Yh p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Administrator 0 : c 0 <br /> E <br /> APPLICATION FOR — LAND USE — PERMITS m 1 <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° nr, <br /> g by application for a Permit for the work described and � a CIO <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the Stale of Wisconsin, o <br /> w m <br /> �/ G/ ie <br /> OWNER ecRin 5�� � TELEPHONE F�Z OGb" 60y/i a F <br /> ADDRESS 5-,g>0 ©.�u n�l�i-S / ��• g �� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> U<Cl <br /> CONTRACTOR �N� Q <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> STRUCTURE/ADDITION USE: o � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> O O VV <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). <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. I <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 a y <br /> Z v <br /> PLOT PLAN <br /> c <br /> 4f�e <br /> C,'-}°fie 5� ARS w <br /> I <br /> E.OIL r u, <br /> Itoi a <br /> w <br /> ci- S vg Iz'xu' 0.12 <br /> �# 75"o Z <br /> 3 i3' <br /> V c-� <br /> _\ b'F� <br /> CONDITIONS OF PERMIT: 6ac� / ? g ,z C g <br /> f. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 'e F ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - to <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 2$� rn <br /> E : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my�nfwr- <br /> owl. L i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all ina- ? «m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 reeopnize that thio p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i i 8 <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 premises i5 reasonabl time for the purpose of inspection. ' <br /> / m , <br /> SIGN HERE `� 1 « <br /> ( Ipnature of ow a oar building c�o{str�actor) (dots) <br /> ZONING ADMINISTRATOR -l+"t ►1 `�-'�•GC•A <br /> i <br /> TOWNSHIP PERMITS MAY BE REQUIRED o -I); R N IS N g m <br /> 888888880 <br />