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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( 0 Z <br /> APPLICATION FOR — LAND USE — PERMITS 3 0 — <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. rn m <br /> a m <br /> cm O <br /> OWNER C��Q/�Lo P e TELEPHONE 7eS- ?S`�- 3��a n 0 <br /> ADDRESS 9-71 �G- RS /S IJ�P� m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax recei t) <br /> CONTRACTOR Rf�- GIoV� .QU eTd�C.I 1� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> o <br /> STRUCTURE/ADDITION USE: Sx <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc-) z o <br /> o VV <br /> m <br /> } <br /> DIRECTIONS FOR PLOT PLANDRAWING: (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 we I (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 -q <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitt d by an architect,engineer,builder,contractor,etc.,the plans must be signed and n <br /> dated by the owner. C o m <br /> NOTE: BUILDING/STRUCTURE LOCA IONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 Nr <br /> PLOT PLAN Z Z <br /> Seco S w�v,�e� peiin{�# �9�`1 M 9) L. <br /> C <br /> a r� <br /> N <br /> r <br /> o <br /> o <br /> N <br /> Z <br /> I C <br /> ��ro a0 � <br /> F <br /> m 33 0 ce. 31 <br /> CONDITIONS OF PERMIT: < w' Z CS =e �+ <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a m �'z <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. J[-t vt 2 G <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: - C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- d. m <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be rf lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $`8 $ <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing in this ap- y, x <br /> plication.I agree to permit coup y officials charged with administering county ordinances or other authorized person to have ON a; <br /> access to the above described premises at any reasonable time for the purpose of inspection. „ 3 ob <br /> SIGN HERE � <br /> (ai er atu a of ownuildinq contractor) a N <br /> oi <br /> �/ x <br /> ZONING ADMINISTRATOR %CC ' g x <br /> TOWNSHIP PCRMITS MAYBE REQUIREDo N N N m <br /> 000g'�i$ $ rmn <br /> ss. <br /> 0 <br />