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Burnett County ,e10 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d a0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 3 n <br /> regulations of the State of Wisconsin. o <br /> m m <br /> w <br /> c <br /> � <br /> O <br /> TELEPHONE II _7 7C <br /> ADDRESS IV yC <br /> lSy✓I S tel. I L r Yl(� a'* �( � 'bO LUI -" .n ��{� m 'tU <br /> EMERGENCY/FIRE NUMBER ROAD NAME �—✓AHC F1G� <br /> LEGAL DESCRIPTION (see tax receipt) ✓�T ��Sk Qu''�.�-c'� �'E ,/�" Q`'",'/'2'i Sec{;vim rn <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION p <br /> n <br /> SANITARY PRIVY0 <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> STRUCTURE/ADDITION USE: J ��ize J Y'�L>� I� /x I D, o o <br /> (Home/Cabin;tornmercial Business; Bedroom;Deck;etc.) T <br /> Zo <br /> o a <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. Q <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In <br /> 0 v N <br /> PLOT PLAN z <br /> 0 <br /> o n <br /> co o <br /> M W <br /> 46ac�k_, X 10 PO4-A) '" C, v� <br /> �l�Se�G'aGl `S hal/c 111gef11/ 177 l L• I <br /> m <br /> 0 <br /> J <br /> N <br /> O <br /> J <br /> J <br /> m 1 <br /> N IVu <br /> V <br /> Z <br /> I1 ,rvt 1. <br /> V <� <br /> G <br /> m> ao � <br /> "' >og� 2.aOeemm <br /> CONDITIONS OF PERMIT: v N,: C 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F '0 ' 91,E : ' <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. 4� ,rd'ii L)' m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- to m H m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o�$ 0 <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 rN„ O <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m o m <br /> T :` 3 03c' <br /> m A m <br /> SIGN HERE 0 ' <br /> (signatu of owner o ntra o (date)— <br /> ZONING ADMINISTRATOR <br /> TOWNSHI PERMITS MAY BE REQUIRED O N N N UN p m <br /> 0000000 (0 <br /> 0 <br /> /1 <br />