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M <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator da 0 0 <br /> -APPLICATION FOR — LAND USE — PERMITS 3. <br /> b <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. y m <br /> n w <br /> OWNER �'�1 d)9 C —Thompson TELEPHONE612-�3B-� 16 6 <br /> n m (b O <br /> v <br /> ADDRESS m m <br /> � �c l�I�i �1�Chc1Y►iC ' I� �A ,CYnlh. 5�11� <br /> EMERGENCY/FIRE NUMBER nXn ROAD NAME TI � Kn...moi' ^II <br /> LEGAL DESCRIPTION (see tax receipt)-r.(''# 3`1`116 , �7 L , D9a 60 PIUUAJttt"'fffSYYYRRRff,_CS4! ' <br /> CONTRACTOR 1 �. O� v (_ �> <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> �[ n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT, o <br /> _ SUBDIVISION o 0 <br /> 9 /l J <br /> STRUCTURE/ADDITION USE: amiolnq (1A �/Y�.c�/IL(S �nC(�I�S/(��(4/ ✓�R�,I�S o r <br /> (Home/ n;Commercial Business;Bedroom; eck;etc.) Z <br /> 0 0 <br /> D <br /> N <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). o <br /> 3. Show dimensions in feet 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. <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A N <br /> PLOT PLAN LAM 4� V e � o n <br /> n <br /> Z m OQ o <br /> r C i '/z <br /> i <br /> Ijn <br /> 4� Z <br /> S (�(n­unr D DO 'y <br /> R -g� 2am ems <br /> D- fo x <br /> CONDITIONS OF PERMIT: '^ y.: CS .- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 6o DAYS OF PERMIT ISSUANCE. o 0 �Z <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. 32 : m <br /> $ : to <br /> e : O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 !D 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- «.w a <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. E B g <br /> mation t am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <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 hav ? O N p <br /> access to the above des premises at any reasonable time for the purpose of inspection. m bg <br /> E a0N: <br /> N m <br /> SIGN HERE IX ' <br /> si ow building contractor) (date) i 8 <br /> 0 <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIREDo N m <br />