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County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR — LAND USE — PERMITSa 3 <br /> TO THE ZONIN,6 ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � H <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 n p <br /> regulations of the State of Wisconsin. N o <br /> OWNER K�h k . h l� (�yU TELEPHONE a <br /> lll�l` 1 O <br /> ADDRESS I? ! <br /> EMERGENCY/FIRE NUMBER !"\ F F/ ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / 1 i w l:I <br /> CONTRACTOR ��,- LLL f <br /> `! n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° <br /> -►�f�L� Sera�,5� � `1 f�� 7�S° m r <br /> STRUCTURE/ADDITION USE: o °» <br /> (Home/Cabin; mme cial Business;Be om;-Deck;etc.) Z <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 (DIF). <br /> 3. Show dimensions in feet ofthefoliowing:(a) building to all lot lines,(b)building to center line of road,(c)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 signed and <br /> dated by the owner. C o <br /> NOTE'. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> PLOT PLAN n o n <br /> //1 m o <br /> r <br /> rr` O <br /> lCl � J <br /> N <br /> O ry <br /> J �.1 <br /> 7 <br /> b <br /> O � <br /> N <br /> 7v/1 <br /> (� <br /> Z <br /> -- I <br /> f <br /> M N (n � (ArDDF m <br /> M o c . m m 0 n <br /> m. D L m a a D <br /> CONDITIONS OF PERMIT: Z <, a 0 Co. aro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T 0 <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. ' » : C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : o : i m a m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- v. m e. 0 <br /> tion contained in this application(including an accompanyingschedule and I further declare that I recognize that this infor- <br /> mation <br /> N <br /> PP (� 9 Y 1 9e N <br /> I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 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 ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the above described premises at any re sonable lime for the purpose of inspection. iQ <br /> n A <br /> m H 8 <br /> y/J 9 H <br /> SIGN HERE <br /> ( net u of owner ilding contractor) (date) i [ <br /> ZONING ADMINISTRATOR tip" I 8 <br /> O. <br /> TOWNSHIP PERMITS MAY BE REQUIRED V N N O N O O O m <br /> 88888888ai <br />