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�" mwg3, <br /> Burnett County 7410 Co. 11d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator IV o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The L ndersigned agrees that all work shall be done in accordance with the requirements of the A m - <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. is m <br /> OWNER (LHS Df)` �C + [ /TELEPHONE 03-_ 385-- g011 <br /> ADDRESS 3`310„ /�7 L! C ^ I AIRI Ax I 7—2-02) <br /> EMERGENCY/FIRE NUMBER �QiS ROAD NAME 'PI rE BE.NC) Ro �- > <br /> LEGAL DESCRIPTION (see tax re eipt) )I <br /> 1 _ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° (� \ <br /> y <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z O o \� <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 -1 <br /> measurement to the ordini ry high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A I <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7i `0 N <br /> c <br /> PLOT PLAN w .0 a <br /> M < <br /> III -`O ° Zl <br /> C J <br /> in J � = <br /> i <br /> Orr ROD - <br /> N <br /> w n <br /> 1 r <br /> N U J� <br /> O <br /> J <br /> J � � <br /> m �I <br /> y <br /> N <br /> ^J <br /> \ I <br /> Z <br /> 9 <br /> G <br /> A p in�y Dd 0 <br /> m grSJa� & rn <br /> CONDITIONS OF PERMIT: <br /> '- m„ : ZCS0m i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F <br /> D. <br /> TQ : 1 <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N >7 <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N: i 62 : m <br /> o a2 O <br /> I declare that this application i 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.1 acknowledge that I am responsible for the detail and accuracy of all informs- W — : a m H; m <br /> tion contained in this applicat on(including any accompanying schedule)and I further declare that I recognize that this infor- _ is g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I oo <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 bo <br /> m m A 0 <br /> SIGN HERE <br /> ( i i, ( �, (date) �' x <br /> o <br /> ZONING ADMINISTRATOR C r a g <br /> � j <br /> TO <br /> u a"«8 v. T <br /> TOWNSHIP P MITS MAY BE REQUIRE U`U� o M 0 N N � N m <br />