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t�llw <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3_ <br /> m O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 <br /> regulations of the State of Wisconsin. H m <br /> w � <br /> A ^ D n n O <br /> OWNER IGµ�Z^ /V �,/ A I S K ( TELEPHONE <br /> 1 rrr�"`"""/TrV CCCJJJ O <br /> ADDRESS � ' bV� AV � II1 � 0Y <br /> - � <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ,{ g� l <br /> LEGAL DESCRIPTION (see tax receipt) ND.r'1-T f E hiLT /`C-2 CE )OMTR 64l ,TQ dMT✓=rL <br /> L <br /> � ��C'f`T�OT17 LL /.J IPw Mr 3,T ,Ue,QT <br /> CONTRACTOR o/ �u.: 4 N 1 F-r S ON <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—4— ADDITION orj <br /> n GJ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT ` SUBDIVISION a <br /> STRUCTURE/ADDITION USE: �(JINQAYLA) 3(a <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 0 <br /> 3 <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 infeet of t6efollowing:(a) buildingto 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. 0 <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 3 m <br /> 11 z o <br /> PLOT PLAN o a <br /> m y <br /> fin 9, <br /> � " m <br /> �;�� b�►L JOEw <br /> 1ZT <br /> /001 (� <br /> I in <br /> Dor O <br /> d o <br /> 0 <br /> O <br /> 32 o Ul <br /> 4, � <br /> b <br /> O � <br /> 4��Cpe e IWO <br /> I� <br /> >> O -o <br /> 2. m m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p E 0if "1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y^, =N S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O1 O m <br /> a : g € v <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) = o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 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 <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 y, <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the aboveeripramises at any reasonable time for the purpose of inspection. B n <br /> T 3 F: <br /> m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR `- <br /> N N W N NN71 <br /> TOWNSHIP PERMITS MAY BE REOUIRED O U U N N N O MITI <br /> 0096000960 , 90 <br />