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6-�) ccolp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W 'a <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 /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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 /> o m <br /> m m <br /> OWNER EVCn G�_ 7 TELEPHONE <br /> ADDRESS g1 7 m <br /> G J�v Zai! ce -slstn Ley 'eo.'70 — £8s� r. A.�l a g¢ ?9 3 <br /> EMERGENCY/FIRE NUMBER i ROAD NAME 1 <br /> LEGAL DESCRIPTION (seetaxreceipt) LDS <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a a <br /> 0 <br /> J — <br /> r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 ° <br /> D <br /> N <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 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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED o m <br /> PLOT PLAN o n <br /> C <br /> J <br /> In <br /> ( <br /> ) <br /> ° <br /> 0 <br /> J <br /> N <br /> O <br /> J <br /> O y <br /> N <br /> Z <br /> jo <br /> rOA <br /> > a <br /> m. 9m aa. mM <br /> CONDITIONS OF PERMIT: a 0 m : Q c S � i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o: S Z . ; - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° f ' ` ` '-1—rn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C.;9 m <br /> o <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- u m`n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- $ is g <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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 O o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> m E 3 <br /> SIGN HERE �•ls�,rdC.Z : -'"-' ' `� <br /> (sign a of owngr pr building contractor) F10)F <br /> o� p��._`�.`_ ' <br /> `.' 3 i <br /> ZONING ADMINISTRATOR g ; E <br /> TOWNSHIP PERMITS MAY BE REQUIRED G N N 4 N T <br /> O N N 5 r N O, m <br /> II_ l o 0 0 o g o b m <br /> o N <br />