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I <br /> Cou" 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> a <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 m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m C <br /> c <br /> OWNER � ��IR�S,VI�11TELEPHONE <br /> r <br /> ADDRESS 2UD3 WOOOS WtV <br /> EMERGENCY/FIRE <br /> n0 <br /> n <br /> I <br /> NUMBER �('�'�/•� ROAD NAME <br /> LK �gz_. i •�_..)\ <br /> LEGAL DESCRIPTION (see tax receipt) v_ + Xbb�AA1���000���llIDDD 6K �-N•./ QL.— <br /> CONTRACTOR _S: <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Vl o <br /> 3 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° !(`. <br /> m r <br /> 0 <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin,Commercial Business; Bedroom;Deck;etc.) Z o <br /> o � <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 in feet of thefollowing:(a)buildingto all lot lines,(b)building to center line of road,(c)building 11 <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. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 11 3 m <br /> c <br /> Z o <br /> PLOT PLAN n o a <br /> n19� a <br /> C i ' J <br /> AVOW <br /> N <br /> m <br /> ° <br /> 0 <br /> J <br /> N <br /> O <br /> J " <br /> J <br /> N <br /> Z <br /> F <br /> A p,a..0 0i a :E <br /> m — iii 2 a m Q m m <br /> a m <;: fir Cog <br /> CONDITIONS OF PERMIT: m Z C $ J,p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zm 0 : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o £ J � <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. \'� o : i 62i i 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o': m 0 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- >j '� «�y«+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 i $`ia $ <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 O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 $ <br /> D w i w o i i <br /> SIGN HERE <br /> (si atj own r orbuilding contractor) (date) <br /> ZONING ADMINISTRATOR �)� " "`�'r _ <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ o " 8 N m <br /> $ $ $ imp <br />