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�Il I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminlllitrator U) 'a <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the m c 1`N�/V <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the Iws and 3 '\ <br /> regulations of the State of Wisconsin. A-� <br /> n1 /] / m �y <br /> OWNER /�-, 2�� yf I /I�/ ��.L�`�1� TELEPHONE �� - Z177C-, <br /> ADDRESS /`(r)y� 7 ' S I• <br /> EMERGENCY/FIRE NUMBER ROAD NAMEvcc <br /> A f \ �J <br /> LEGAL DESCRIPTION (see tax receipt) 1 _�r�1 .'V _l� —3�'� ( � C') <br /> CONTRACTOR llllllJl <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING VAMPING UNIT ^ SUBDIVISION o <br /> fi�nn••nn `� 1 m r <br /> STRUCTURE/ADDITION USE: l flm l�C - S P' o <br /> (Home/Cabin;Commercial Busines ; edroom; Deck;etc.) I v <br /> 0 0 <br /> 0 <br /> m <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 Nort (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DIF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c) uliding -q <br /> measurement to the ordinary high water mark of lake, stream,or river. 0 <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> 0 <br /> dated by the owner. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. III a N !" <br /> PLOT PLAN �, 0 / <br /> o n <br /> o <br /> C <br /> \0 MCT�� `nirrl <br /> i� <br /> N <br /> m <br /> o <br /> 1 ° I � <br /> n <br /> d <br /> v � <br /> (A <br /> g'f m <br /> 6 . <br /> CONDITIONS OF PERMIT: < [ Z $ 8 7+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o < 5i 'Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` rn : ' O : m <br /> ar O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of rny knowl- i O E ? <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- ;"m'� T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i 81 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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the above described premises aty reasonable time for the purpose of inspection. 3 <br /> o <br /> m - <br /> GGyL � <br /> » ` " <br /> SIGN HERE � � «• <br /> (signature of owner r uil (date) <br /> ZONING ADMINISTRATOR <br /> 8 <br /> MM� MMN+ Zt <br /> TOWNSHIP PERMITS MAY BE REQUIRED N 8 N 8!S m <br /> 0888 888 Un, <br /> �I <br />