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NC <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m VI <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. - _o <br /> N � <br /> OWNERRi� atiVCI ' TELEPHONE <br /> 553 - 0Q31 <br /> ADDRESS vn PAI oliyh m� 55 07- <br /> I�y3�) 5�1 A>« Flo J <br /> EMERGENCY/FIRE NUMBER ROAD NAME T 1QJ) rnow,d <br /> / r' <br /> LEGAL DESCRIPTION (see tax receipt) Qvi-nrrunt Lb I , SQL'- /5 3L� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING w GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O 1• <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <br /> STRUCTURE/ADDITION USE: °— <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> O ° <br /> 0 <br /> m <br /> a <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 (DIF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building -4 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 cn <br /> PLOT PLAN o n <br /> fn o <br /> 4) N <br /> 5 m !J <br /> 1�) <br /> I N <br /> m <br /> J <br /> . S <br /> 0 <br /> � M <br /> o � <br /> N <br /> 1� <br /> Z <br /> a <br /> f <br /> M �'c�< + r0 a0m <br /> m—$`G; 2. o:m m <br /> CONDITIONS OF PERMIT: <br /> m:5 : CS 0, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o rZ i : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !^ I L7 n m <br /> O i : ig2i i <br /> 2 O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- E : e. <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I Ji i $ $ <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 haveO N a <br /> access to the stave described premises a ny reasons a for the purpose of inspection. ' °' b m <br /> vApp0 <br /> ( M N O <br /> SIGN N E `.-I yam, I�l.� `� -7-.?q - 93 <br /> (si t e of ow r r bu'ding c ntractor) (date) �E P <br /> ✓��/f�P o xE [ <br /> ZONING ADMINISTRATOR �-�✓w" <br /> $ i o <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N UO UN N a m <br />