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AzI cer p, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m e o a <br /> APPLICATION FOR — LAND USE — PERMITS ` <br /> m ' <br /> TO THE ZGNING ADMINISTRATOR:The undersigned here makes ° <br /> g by application for a Permit for the work described and � a � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the OM co <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and thelaws and _ <br /> regulations of the State of Wisconsin. v <br /> rn m <br /> m m <br /> c <br /> OWNER —04 S i ) A N e fp J TELEPHON n O <br /> ADDRESS �� 5�(u f Pti.� 1ti PTv r i - MV !3 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) '1 v LCY <br /> Lot (..S� <br /> G ff V <br /> CONTRACTOR 1`L Dcne �� Me 1 Fe f`t uS i:r\ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> - _ <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> H <br /> STRUCTURE/ADDITION USE: Fb(IL1L5. Z LU h L i.`"f 15 b6kci A Q ti e (c )trI ^(' o a� <br /> (Home/Cabin;Commercial Business; Bedroom;De tc.) <br /> 0 o <br /> o v <br /> 1 _ <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 dralnfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,( building <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 s lined and 0 <br /> dated by the owner. O <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. i rn <br /> PLOT PLAN (U 3 i 0 ` <br /> n o a <br /> oc J m <br /> \; -A <br /> 1�( JJ <br /> m <br /> 33 <br /> 'OE ma <br /> o � <br /> ,I <br /> 1 7`J <br /> Z <br /> Q <br /> ti <br /> CONDITIONS OF PERMIT: 1 - j 5 Ii`. o Z c 8 M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH R QUI EMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o 1'R <br /> F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o <br /> c � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ^ !7 f5 y <br /> m <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 II informal. O P <br /> ed a com �3 <br /> p g i «m « <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- i $ g <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I E i i <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. <br /> SIGN HERE <br /> ($I lure citlowner or building contractor) — _.(datel <br /> ZONING ADMINISTRATOR <br /> MM I TOWNSHIP PERMITS MAY BE REQUIREm <br /> �88888 (MA <br />