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ny) C"a <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ' o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the m c, <br /> Burnett County Land Use Ordini ince, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 °- <br /> regulations of the State of Wiscc nsin. �, m <br /> OWNER t C a r G V1(-Lk 6-r TELEPHONE 32 7- <br /> G. J £ <br /> ADDRESS ry I i <br /> EMERGENCY/FIRE NUMBER ,z a ROAD NAME e Rd L <br /> LEGAL DESCRIPTION (see tax receipt) S'7-f T37 r CELS Cao .o>`' 2 <br /> CONTRACTOR Se I-I" <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> G) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: Ra �GG� -a A/ C3AI o <br /> (Hcm abin Co mercial Business;Bedroom; eck etc.) Z o <br /> P a <br /> m <br /> D <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 thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of 1 hefollowing:(a) building to all lot lines,(b)buildtngto center line of road,(c)building -4 <br /> measurement to the ordina y high water mark of lake,stream, or river. <br /> 4. If separate plans are submi ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o m <br /> 7I z `c <br /> PLOT PLAN A 0 a <br /> 5N C I <br /> ---- r R <br /> l lam` <br /> 1 <br /> to <br /> J�F m <br /> 0 <br /> N ~ <br /> tj <br /> Imo` <br /> m c m m o a o <br /> ,NDITIONS OF PERMIT: gy m : .z C 8 0. 0 T+ <br /> )RIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. zm 5 : Z'2 <br /> IEMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o T :�: M <br /> O GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. � HNo a2 : m <br /> to <br /> i a i C <br /> e that this application(i icluding any accompanying schedule)has been examined by me and to the best of my knowl- t� � o : j m <br /> d belief it is true,corre t and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- W! «.w m <br /> tained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �? cl p <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o a <br /> :cept all liability whict may be a result of the County of Burnett relying on this information I am providing in this ap- L/j i 1 i <br /> I agree to u ty otficiel3 ch gad with administering county ordinances or other authorized person to have O o <br /> thea describ premises at BOY r o I ime or the purpose of inspection. m 3 0 <br /> D V y :H <br /> (Si net ner or buil ing contractor) '(date) i I rio <br /> ; N,- al :'� kIm <br /> TOWNSHIP PERMITS MAY BE REQUIRED j { N m <br /> o0000 0 <br /> r <br /> 0 <br />