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eA , <br /> Qyme{t County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator ? o <br /> APPLICATION FOR - LAND USE - PERMITS m - <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m $ `- <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and thelaws and o _ <br /> regulations of the State of Wisconsin. a m <br /> c <br /> m P n <br /> OWNER TELEPHONE rG12 O -$23� m �I m <br /> ADDRESS 10511 PACMRD 5 N-E, GRu,E P 5 6501 Li <br /> J l' <br /> EMERGENCY/FIRE NUMBER NLA ROAD NAME OLD 35 <br /> LEGAL DESCRIPTION (see taxreceipt) PO,;a 441103 0, OtLkoD 43 CSAn V I P90 rl <br /> t <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O �� <br /> G) Q( <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 °- <br /> w r <br /> O O <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 a <br /> 'm <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 (f). r <br /> 2. Show the location of the well (W),septic tank (ST),and dralMield (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. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and U <br /> dated by the owner. 3 Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN EE ISSUED. <br /> 71 z c <br /> PLOT PLAN 5C,4 A,ffAWeD O o C u I <br /> IO p <br /> 1 <br /> .: N <br /> c <br /> 0 <br /> Lz. <br /> i <br /> C� <br /> f <br /> a <br /> K: <br /> Q Cw g._. <br /> CONDITIONS OF PERMIT: �'9o'' . �Z <br /> Z e : <br /> 7. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the bet of my knowl. G <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accurst of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further the <br /> that I recogniz that this infor- . <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to ii sue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am Prov ding In this ap- <br /> plication.1 agree to permit county officials charged with administering county Ordinances or other authorized person to have , ; is . . <br /> access to the above described premises at any reasonable time for the purpose of inspection. azt <br /> o w <br /> SIGN HERE N <br /> /fo LAI <br /> (signature of owner or building contractor) (di e) <br /> g <br /> ZONING ADMINISTRATOR - <br /> MMN�NN MN+ <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N WO '�'^'S <br /> 888888'88 <br />