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cm cc-a l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d It o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> TO THE ZOt,.1NG ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the <br /> M c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. y m <br /> w <br /> C <br /> OWNER TELEPHONE n <br /> ADDRES <br /> EMERGENCY/FIRE NUMBER ROAD NAME I ldlli 1 e� <br /> l <br /> LEGAL DESCRIPTI (see tax recei , <br /> 1jer C qL <br /> CONTRACTORS / /' 'Ad '"+'1 ee't s � <br /> TYPE OF PERMITS): DWELILI—NG/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> \)/ O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o < <br /> �y c <br /> STRUCTURE/ADDITION USE: Ity' V e'k 4 <br /> (Home/Cabin;Commercial Busi ° <br /> s; Bedroom; D k;etc.) Z 0 <br /> 0 <br /> O <br /> N <br /> 3 <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 Nor It (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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be si tied and M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. ON3 toon <br /> I� <br /> PLOT PLAN Z <br /> 0 0 <br /> f� <br /> C I i <br /> �) a <br /> / � v IQ t � goo �ptJl+'r'� ale Int <br /> 5' r <br /> 9,51' yK e G� Jt <br /> St we`pe <br /> t � <br /> Y � o <br /> o' <br /> 7 <br /> J <br /> R1 rin ISe n <br /> PU 'I +{ f � Z <br /> N�v+ I � <br /> e Un75t�� �-ow� S-fc�� S �-rtooCloae <br /> ro C)l-Kolyt 0 <br /> 11)- Rlu,r. sYtil�ea cv dw{w( b O <br /> Sefl XXL re,11 11L <br /> 11 D r� <br /> c Com.2 �+ f <br /> CONDITIONS OF PERMIT: v N.: Q %L 8 - <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 o Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ y y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <�n : 0 O <br /> 0 � ` C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- o: <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : «r y i': m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i3 0 ; C <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 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 have 0" 0 <br /> access to the above d cr remises at any reasonable time for the purpose of inspection. N 0 0 <br /> m V O 0 <br /> ^ <br /> m O <br /> SIGN HERE �� r� ` ` o <br /> . .,. - i . <br /> (signature of ownrrlbuilding contractor) - -- 7 II ' 8 ' <br /> ZONING ADMINISTRATOR 3 <br /> — « « aa� „ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Oen Un N N j N N J N N <br /> vi tit <br /> 0000000 m <br /> Cn <br /> 0000000 <br />