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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u z <br /> m £ <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 /> locaMd as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the mm <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. - o <br /> in m <br /> m � <br /> c <br /> OWNER / L 17 <br /> TELEPHONE �Z�_ y3�7-J%lv a O <br /> ADDRESS ©l0 T ,:5-L ice.-T'ti' /IILI ITiI ar. L 5-©tl� <br /> EMERGENCY/FIRE NUMBER n e L 9 t j� <br /> `I , j'/ROAD NAME _�C 1gpuK / /` <br /> LEGAL DESCRIPTION (see tax receipt) -lr' / d <br /> ppJ f � S�'C�., /.5 <br /> CONTRACTOR ILI <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n G7 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 ---7- <br /> o <br /> STRUCTURE/ADDITION USE: 6Lrc-'E 91)- 9Y+ / PWD <br /> MOH u <br /> ry- <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc. <br /> Z <br /> O O �V <br /> A <br /> 3 <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 infeet ofthefollowing:(a) buildingto all lot lines,(b)buifding to center line of road,(c)building 14 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a y <br /> PLOT PLAN / /// o a <br /> Mo <br /> C <br /> N t <br /> IA <br /> t C), <br /> N <br /> � j t o <br /> ��a owrir ws� ll -j v 1 <br /> a o <br /> Qwth<l�S <br /> \\U yk <br /> Z <br /> a (n(n -uLn r-D DOy <br /> /'/ <br /> / OG�� A - a =. 90amm <br /> ELr CONDITIONS OF PERMIT: v m-: C 805 i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> E o 0 �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : =N i E y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N G)2 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. «.m>: 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. > o'8 o <br /> o o : <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ; ow o <br /> access to theabove described pre is at any r asogbie time for the purpose of inspection. m m <br /> 0 <br /> SIGN HERE o <br /> (signature o(owner or building ontractor) (date) 8 ` 'B <br /> : s: <br /> ZONING ADMINISTRATOR <br /> g <br /> TOWNSHIP PE ITS MAY BE REQUIRED <br /> m <br /> 00 0 oc <br />