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an ca <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permitfor the work described and v L <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 a <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> 0 <br /> regulations of the State of Wisconsin. w m <br /> c <br /> // m O <br /> OWNERi�/� D 0 8 !' GL' TELEPHONE <br /> w <br /> ADDRESS 1 a I <br /> EMERGENCY/FIRE NUMBER ,�� ROAD NAME <br /> LEGAL DESCRIPTION (see texreceipt46=5 <br /> 30�� OSM iie i_ P30 _ �. V. 1-,,7--3 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE__ ADDITION <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> STRUCTURE/ADDITION USE: =(H, <br /> W Pr I'OR ra7YNO'e, ARiA Y DESi��-ea0 Frd ° <br /> v <br /> bin;Commercial Business, BedrooDec a ctk .)2L'S /ONd1Z T 71'ouSG`• o <br /> 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). <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 /> n <br /> dated by the owner. Q ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v N <br /> c <br /> _ Z o <br /> PLOT PLAN o a <br /> m y <br /> o <br /> Pj i r L NC <br /> SAF �i i��y <br /> o <br /> 0 <br /> va, o <br /> qkP,14k <br /> Z <br /> M c Mira a0 � <br /> m DK'� 2.aw a0Mm <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _^� <br /> H; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I 0 iD A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o - C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- 0 m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- O <br /> mation I 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 <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N m- <br /> access to the above described premises at any reasonable time for the purpose of inspection. r <br /> Oil <br /> - <br /> SIGN HE "z <br /> (signature wne or Duildi contracto (date) <br /> o : <br /> ZONING ADMINISTRATOR <br /> �NN4�NN N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 000 0 o b o m <br /> 0000 $ 0000 <br />