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enC"p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <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 the laws and 3 <br /> regulations of the State of Wisconsin, <br /> TELEPHONE O r <br /> m `^ <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER w�C�o ROAD NAME U.L y 17 t V <br /> LEGAL DESCRIPTION (see tax receipt) e- a�, e1�r.SPL /� ���jr-�j�� I(,� S L.//,-,�S' W rd <br /> CONTRACTOR /S /T� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> m` <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° S <br /> STRUCTURE/ADDITION USE;.< - SE /O,A!q[77c++�-- ° ro <br /> (Home/Cabin;Commercial Bus,ne..'EtZd rn; Deck;etc.) Z v <br /> o ° <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 (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 t/x <br /> measurement to the ordinary high water mark of lake,stream,or river. kA a <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. O 3 O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> PLOT PLAN /lj�ryf' L/JfE� 6t1Mr o n <br /> Zoe r <br /> 1 M W J <br /> f a ti� <br /> Cio <br /> 0 <br /> Qr = <br /> !� fro OTU CCC �ro� H r� 0 (_ <br /> o l/V <br /> m <br /> O � <br /> N <br /> IA/ I� <br /> Na <br /> And <br /> f <br /> Ny�k,Wy �r>> <br /> - i£1� '- am Pa m <br /> CONDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F `z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rr' ;: O m <br /> iLO <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I 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 oo <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. p1 <br /> T a <br /> � m <br /> N N <br /> SIGN MERE u <br /> (signatuer r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> �ww«r f2! Nw en n <br /> TOWNSHIP PERMITS MAY BE REQUIRED O NT N N N N p N In <br /> 0000000000N <br />