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N (M ), <br /> Burnett County 7410 Co. Ad. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o 0 <br /> APPLI ATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRA OR:The undersigned here makes ° <br /> 9 by application for a Permit for the work described and w <br /> located as shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinince,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n OO <br /> regulations of the State of Wisc nsin. o <br /> m <br /> r_ <br /> m <br /> OWNER �� v /� TELEPHONE <br /> o <br /> ADDRESS _ (/1 <br /> EMERGENCY/FIRE NUMBER ('{'` ROAD NAME (L� <br /> i� <br /> LEGAL DESCRIPTION (see tax rec ipt) IC'-7 IS <br /> , ,ILL /e <br /> CONTRACTOR SY L <br /> V <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 13 <br /> SANITARY PRIVY FILLING/GRADING CA ING UNIT SUBDIVISION r' O <br /> 0 <br /> �- afar o <br /> N <br /> STRUCTURE/ADDITION USE: 636 T� 0 0 <br /> (Home/Cabin;Commercial Busins; bedroom Dec ek tc-) <br /> Z <br /> P � <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLA 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). o <br /> 3. Show dimensions in feet ofthe following:(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 submi ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 U\ <br /> dated by the owner. 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 w <br /> PLOT PLAN � o� c <br /> LSI Lane, <br /> -- m o <br /> C <br /> to <br /> M <br /> N <br /> N8. 1 <br /> p y. J ti <br /> r 2L'r ISTi"� rF, <br /> ohKr A � cM0arnrn <br /> CONDITIONS OF PERMIT: v <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I N 2 m <br /> I declare that this application(inc uding any accompanying schedule)has been examined by me and to the best of my knowl- o'iC <br /> m <br /> edge and belief it is true,correct i nd complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B <br /> mation I am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o`$ <br /> further accept all liability which ay be a result of the County of Burnett relying on this information I am providing in this ap. <br /> plication.I agree to permit count officials charged with administering county ordinances or other authorized person to have <br /> access to t above described p mixes at any reasonable time for the purpose of inspection. : ON bm <br /> m [ m <br /> n <br /> SIGN HERE w :o <br /> 1 1 _ <br /> (sign tura of wn r or ildl contractor) A �'i' I _� �/��to�k./ -' i� ` .2x ` <br /> O ; <br /> ZONING ADMINISTRATOR I I. 8 x i <br /> My ; „aa�„ x <br /> TOWN 1 610 I T PERMITS MAY BE REQUIRED �I rl t o m <br /> w <br /> 0 <br />