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mc"'/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U ' c c <br /> '-. <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 3 <br /> m , <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v g <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 8 <br /> regulations of the Stale of Wisconsin. �, t <br /> b 0 <br /> OWNER n TELEPHONE o. i <br /> /(o�lz� /lt��J ��Qmrnc� fplZ-��� G2lc� m m <br /> ADDRESS /7/70 &:WV00tY C-/ La1&11k- XAI( 15-jz>y! m \ \J <br /> EMERGENCY/FIRE NUMBERZ O4g-S �,�, l S� ROAD NAME <br /> .n <br /> LEGAL DESCRIPTION (see tax receipt) L <br /> CONTRACTOR - `, "``1111 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE A ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o ni <br /> R. <br /> STRUCTURE/ADDITION USE: 1600-11 ,X -:-)-C) o ° \ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> O a <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 (NEI) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 0 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building .4 <br /> measurement to the ordinary high water mark of lake,stream,or river. c <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M - <br /> dated by the owner. () 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 y <br /> 7I Z Q <br /> PLOT PLAN II I 11 1 <br /> s;i ec12c� <br /> A <br /> S y <br /> O <br /> 0 � <br /> b <br /> �- O, . <br /> p <br /> e <br /> hq5 k <br /> 43 <br /> Io' IATrn <br /> u f <br /> Vr1rU_� mo w. it C r m y <br /> CONDITIONS OF PERMIT: ^ < 20 ; 2 8 gra � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF?EFiFAIT ISSUANCE. o £ 0 �Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. l./ m <br /> �_�i 0 E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o l i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- •+m e' T <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 detem ming whether to Issue I permit. 1 813 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this sp- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized Peron to have m: m <br /> access to the above described premises at any reasonable time for the purpose of inspection. , 3 <br /> SIGN MERE r <br /> (signal re of owner or building contractor) `� ;L'= a - <br /> ZONING ADMINISTRATOR <br /> 'MHN�NM NN+ 7l <br /> TOWNSHIP PERMITS MAY BE REQUIRED 111 t 8 N N N f5 m <br /> U J 8888888 vmi <br />