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C97 &071P <br /> Surneff "nty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator y -a z <br /> f <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <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 lin s and <br /> regulations of the State of Wisconsin. o <br /> / m m_ <br /> OWNER / y� o e <br /> TELEPHONE _y�J � n £ <br /> ADDRESS <br /> r <br /> EMERGENCY/FIRE NUMBER ROAD NAME r <br /> 1. <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION j <br /> STRUCTURE/ADDITION USE: ! "Usv F'O ,4- Decl <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> o c J <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 i N). <br /> 2. Show the location of the well (W),septic tank(ST),and dralnffeld (DF). a <br /> 3. Show dimensions In feet of the following:(a)building to all lot linea,(b)building to center line of road,(c)b tiding <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 sign d and00 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on c N <br /> PLOT PLAN z o <br /> � o n <br /> in C�' N <br /> See 14*-c� plot IPla 1, a <br /> Nd�e FXts�nt /aVV cec-L 6iv <br /> -to be mr-Lo-�J <br /> �{QFJCP.Gf Coni �—Y"� `S�a • liO � <br /> 1 <br /> 0 <br /> s <br /> m <br /> o <br /> �, ,47, . -{z5 6e- OPO S�eeti a, h - Nr7� �ia <br /> j <br /> 1 <br /> r>> <br /> CONDITIONS OF PERMIT: v' m S lrC, g�' <br /> < ': m � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a ;' ?Q �`6 =Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =N a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. `,� �+� : n In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all in forma- '• N N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- E i 8 B 9 ; <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a Permit. I <br /> 8 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I em providing Int is ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have i i 0i 0i <br /> access to the above described premises at any asonable time for the purpose of inspection. <br /> al O <br /> SIGN HERE `� a <br /> N i <br /> (sip to of owner rpOilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> g . <br /> 4' <br /> TOWNSHIP PERMITS MAY BE REQUIRED N NNN N qNNN rN N H ' <br /> O NNN pO pN fp(IpN pO <br /> 888888'88 <br />