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o <br /> � 7G Z <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 office of Zoning Adminlatretor m a o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. m u <br /> 1 // \ O <br /> j <br /> OWNER RC WQSV TELEPHONE W'tl� . q 6 - q <br /> ADDRESS 1�chlJ(J— s �, �I-)) n ss-'1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME E ; k <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR I <br /> TYPE OF P RMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT �S/U�BDI ION V` 0_ <br /> STRUCTURE/ADDITION USE: S / � � � , r 4t( /r� ? 0 4 <br /> v <br /> (Home/Cabin; ommercial Business; Bedroom;Deck;etc.) o o /� <br /> m 1� <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 drainf laid (DF). <br /> 3. Show dimensions Infest of the following:(a)building to all lot lines,(b)building to center line of road,(c)building }I+' <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 O <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1! 3 ur <br /> 11 Z Q <br /> p p <br /> PLOT PLAN <_. <br /> n ` III <br /> F\-6 <br /> � w <br /> GKCcG?/1e- 7 <br /> C)wRC2 rn'��eL <br /> m <br /> o <br /> VV <br /> Z <br /> _0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 33 <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. L `• G <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- D <br /> ` i <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- �IAA• ` �'m �` Rt <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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. I $� 8 <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 <br /> access to the above described promises at any reasonable time for the purpose of inspection. T i <br /> M� <br /> SIGN HERE (date) [ E <br /> (signature of owner or building conit^rC actor) <br /> ZONING ADMINISTRATOR <br /> rR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N�o NtaN88 $'$8 vm) <br />