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I� Lbo al <br /> Burnett Cour-,y 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m c o <br /> APPLICATION FOR — LAND USE — PERMITS 3, <br /> TO THE YbNING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 � <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. y <br /> w � <br /> +;V^^� O <br /> OWNER / � � TELEPHONE <br /> t.•- VJ(h Ill / w 1`^ <br /> ADDRESS 13 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> — ��tJl�$ EAS-t —" C-A-k612oA-fl <br /> LEGAL DESCRIPTION (see tax receipt) p� I (t('.� I / �1 d/ <br /> CONTRACTOR SCC L-F <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n 0 <br /> SANITARY PRIVY ° <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USES I� rX '� l Iv(C o <br /> (Home/Cabin;Commercial Business; Bedroom;(lack;et .) /a V Z T <br /> / l l/ o ° <br /> cylv <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 (VV),septic tank (ST), and drainfield (DF). <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. 0 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in a 0 <br /> PLOT PLAN �1 o n <br /> S C� A 1 //-A-c_4 --fl C o <br /> nor I y,..,j �A`% m <br /> Ise <br /> r' l <br /> ai ( a d <br /> i <br /> N <br /> (� <br /> 7 <br /> N <br /> O. <br /> J <br /> � y <br /> w_ <br /> ° <br /> Z <br /> ( <br /> G <br /> N O C N OI n n F <br /> CONDITIONS OF PERMIT: = y Z CS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o fIn`z : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ : L)n 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- $ m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- N m'^ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. ); 8 B is ? p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0 o <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 u m <br /> access to the above described premises at any reasonable time for the purpose of inspection. on <br /> In <br /> 9 <br /> m ^ yam: <br /> 0 <br /> N : O : <br /> SIGN HERE M` "�9p-4 ? S/2 /9-3 � - <br /> (sip atur of owner ilding contractor) (date) - <br /> !L 0 ?: <br /> ZONING ADMINISTRATOR y'>/�.i <br /> NNN�NNNN -1 <br /> TOWNSHIP PERMITS MAY BE REOUIRED .0 N � Yn N 0, � u� m <br /> 0 0 0 0 0 0 0 0 0 <br />