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00 Cow <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 : i <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> T <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application fora Permit for the work described and m <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 <br /> regulations of the State of Wisconsin. u et F <br /> c g <br /> O <br /> OWNER TELEPHONE <br /> ADDRESS /// 6?Y 0/ e�l/i�it/S <br /> EMERGENCY/FIRE NUMBER -3691 $ ROAD NAME me/y y,S <br /> LEGAL DESCRIPTION (see tax receipt) L f' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDfTION o a <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` o- <br /> m � <br /> ° <br /> STRUCTURE/ADDITION USE: _y-J^9 Mom 4JU7 ilI't / � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) oZ o <br /> 0 <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 (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 O <br /> measurement to the ordinary high water mark of lake,stream,or river. l7 1 <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. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1A a y <br /> 11 Z v <br /> PLOT PLAN <br /> M 0 <br /> See �ae'iW <br /> w 0 R <br /> ao <br /> o <br /> m <br /> 4 � <br /> N <br /> r <br /> ` Z <br /> .ITV1 n <br /> f le_ <br /> V <br /> is <br /> g � I m <br /> CONDITIONS OF PERMIT: v 31: <br /> . g 1C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 ? :il <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 10 <br /> C <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 of NI informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- g D <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue • permit• 1 <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 deecri remises N any reasonable time for the purpose of inspection. m j <br /> SIGN HERE (dale) <br /> (at Nure f owner or 11 g contractor) G ; <br /> 8j <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER ITS MAY BE REOUIRED o N ! B <br /> 888888i8I8 e <br />