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elvalaft <br /> Burnett County 741(1 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m -. c <br /> ' APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � rA <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. = o <br /> m m <br /> w � <br /> T c <br /> OWNER C J ( � CA E' TELEPHONE 65& 323 n O <br /> n u o ' <br /> m � <br /> ADDRESS 233 %4. Ict4m o SOU11A �- 'PAI,�I_ . M0 - 550 gs— <br /> EMERGENCY/FIRE NUMBER ROAD NAME ( c� <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> CONTRACTOR lJJ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: Sdnt- rul PM( f7(.fdl-1 l a��11 1 / /-t'GLc�C11f'� o 0 <br /> (Home/Cabin; mercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> � m <br /> 7J 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) CD <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 infeet ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building 1A <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 signed and M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I a vi <br /> PLOT PLAN o a <br /> fn y <br /> 0 <br /> C <br /> fA <br /> t N <br /> n <br /> O <br /> ijJ <br /> N <br /> J lJ \ <br /> m <br /> m <br /> 2 <br /> 31 <br /> G <br /> D O c N r>a <br /> m —i�� 2am Q:e <br /> D m <br /> CONDITIONS OF PERMIT: c0 y.; Q c E (3 Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e F 9Q <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: M <br /> M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o O n O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. c m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs: a w« m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 3 8 ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o <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 O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 <br /> N 9 A m <br /> N m pA <br /> SIGN HERE <br /> (signatu a of owner or but 'n co tD 9 <br /> o : <br /> ZONING ADMINISTRATOR , <br /> E R � I � 0 NT <br /> TOWNSHIP RMITS MAY B8Hmm <br /> U 0000 / <br />