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r <br /> Burnet,County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminatrotor <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the <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. m m <br /> c <br /> $ O <br /> rE <br /> OWNER TELEPHONE k12 - C/O . �, O ° <br /> <)/✓/t m e <br /> ADDRESS v 2 rl� <br /> EMERGENCY/FIRE NUMBER - 'S14 70 VA,I) bG4 3 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> n �/1 <br /> CONTRACTO 0A) PROFri-1- <br /> TYPE <br /> -TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> w � <br /> STRUCTURE/ADDITION USE: <br /> 0 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> I`0}'v 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 Noi th (N). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfieid (DF). g <br /> 3. Show dimensions Infest of the following:(a)building to all lot lines,(b)building to center line of road,( )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 M <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 o rn <br /> Z o <br /> PLOT PLAN ° n <br /> a <br /> fn <br /> t <br /> d <br /> J <br /> $� xl � 712iL1 (n 0 <br /> m <br /> v � <br /> w <br /> Z <br /> l <br /> T <br /> g� �aw m <br /> m � <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z e <br /> 4 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. g `• M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �^ O 2S : ` m <br /> I 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 o all informs- «m « i m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize t at this infor- i O <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing this ap- ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized rson to have <br /> access to the above described promises at any reasonable time for the purpose of inspection. �: ' <br /> SIGN HERE <br /> ( ignature of owner Ing n toA L. (date) r� <br /> E <br /> ZONING ADMINISTRATOR <br /> IN Emil <br /> TOWNSH RMIT AY BE REQUIRED u , <br /> 88 888'8 ai <br />