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IN <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N ; ; I o <br /> APPLICATION FOR — LAND USE — PERMITS 5. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described,and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremends of the r Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the lawsi and <br /> regulations of the State of Wisconsin. o, _ �1�Nd /1/, w, w m <br /> (Alp 3 jds MN ssy <br /> OWNER C TELEPHONE /� �3 o O <br /> Y7 m <br /> ov <br /> ADDRESS <br /> n 1 <br /> EMERGENCY/FIRE NUMBER �a�� ROAD NAME RCJ <br /> LEGAL DESCRIPTION (see tax receipt) C/ <br /> U1/'T � LoT- � J <br /> CONTRACTOR �ilQ�ti A4CHIL)Z2— 'Of M i2: ,v 7— 41)C9.eX — <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` o <br /> If <br /> m a <br /> STRUCTURE/ADDITION USE: - G £ OXY JL >CJ - c <br /> TTb I <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> 0 0 <br /> i 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 (4). � <br /> 2. Show the location of the well (VV),septic tank (ST),and drainfleld (DF). <br /> 3. Show dimensions Infest of the 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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o m <br /> PLOT PLAN T ell ? o v <br /> A4,0-rN <br /> C O <br /> FL K'4ed-- <br /> no U <br /> O✓fit- <br /> G8 <br /> Vitt,tt, n <br /> o <br /> w <br /> 0 <br /> 5 J� <br /> S£�Tf p✓ip'� L <br /> �DU <br /> A <br /> CONDITIONS OF PERMIT: o' 2: .2 CS NO IC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p IQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` r" i ` O lS p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my nowt- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all i tonna• y!m �" m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that t 11 infor_ b i5 p <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a nnit. I $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing In is ap. <br /> plication.I agree to pormWcounty officials charged with administering county ordinances or other authorized person 10 have ; E <br /> access to the above cribed ppfmhkasf at an!pfitachable time for the purpose of Inspection. <br /> SIGN HE <br /> (a!g nor or build! g ntrector) (date) <br /> iS ` <br /> f : i <br /> ZONING MINIS ATO1 8 ' <br /> TOWNSHIP PERMITSY BE REQUIRED 'o S m <br /> 8 8 8 8,818 U) <br />