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Bur.;ett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admini trator W' z <br /> m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri ed and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremerts of the v �J <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the I awS and 3 n <br /> regulations of the State of Wisconsin. o <br /> N d <br /> ( C <br /> OWNER �6+1� 11 a.r TELEPHONE /..lZIf <br /> _2C70 n i.0 <br /> ADDRESSrlI{b „VOD A- 4T-4'L6& <br /> EMERGENCY/FIRE NUMBER _qgO ROAD NAME C �N�S r <br /> J - <br /> LEGAL DESCRIPTION (see tax receipt) O 7"0?n,., � re <br /> — <br /> CONTRACTOR � � 24_5 -lC 'C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING _ GARAGE/ACCESSORY STRUCTURE ADDITION <br /> C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> ,//�� o <br /> STRUCTURE/ADDITION USE: 1f0 oN y r <br /> G S I r N6 f�E o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o <br /> a <br /> m <br /> } <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). 5 <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c) 3ullding <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 sig ied and <br /> dated by the owner. o i 1, <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a N <br /> PLOT PLAN z <br /> o a <br /> m . <br /> ._� C1 <br /> j <br /> f <br /> (.J <br /> r r, <br /> N � d <br /> ItIF <br /> L;DEG DOatH f• _ y-�. `y I <br /> I <br /> z <br /> ip V <br /> 0�I�e� <br /> ( 6'e <br /> `� e(N ,�� r Lys, Wls d a m <br /> CONDITIONS OF PERM <br /> a <br /> I I�. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 GAYS OF PERMIT ISSUANCE. o F � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -NIS y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ♦I ji E i 2l yi.i m <br /> o : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl �f o'_ <br /> edge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all informa- l� ; m�°"t: T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- n: 8 B p <br /> Mellon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a ermit. 1 $r$ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have ` ro <br /> d N m <br /> access to the above described premises at any reasonable time for the purpose of Inspection. ' b <br /> SIGN HERE J-/ <br /> (signature owner or D i Ing contractor) I (date) H u � <br /> �: <br /> _ E 0 <br /> of xx4 i <br /> ZONING ADMINISTRATOR . g <br /> x <br /> TOWNSHIP PERMITS MAY BE REOUIREDI i�',"' T <br /> $ $ $w $t'ab $ N <br /> 0 <br />