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6K af* <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementof the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la sand <br /> regulations of the State of Wisconsin. m <br /> a m <br /> c <br /> n O <br /> OWNER TELEPHONE <br /> CCC666/// r� O <br /> m_ <br /> k-IciiI 0, <br /> ADDRESS 7/1 t� .✓Jlsl� 4 e <br /> EMERGENCY/FIRE NUMBER ,vdV ROAD NAMFJ� Lk , <br /> LEGAL DESCRIPTION (see tau receipt) <br /> CONTRACTOR A <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> � L7 <br /> SANITARY PRIVY FILLING//GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: <br /> V _ �� s <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> 0 0 <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). <br /> 3. Show dimensions In feet ofthefollowing:(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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SUED. �I 3 m <br /> 71 Z c <br /> PLOT PLAN <br /> Q o n <br /> A i� <br /> SEE JFT C�tj m <br /> m , <br /> t <br /> M <br /> 1 � <br /> 0 <br /> ° <br /> o <br /> 0 <br /> y <br /> b <br /> Z <br /> m <br /> m. 9i. 31 <br /> CONDITIONS OF PERMIT: < <br /> R. <br /> : C 8 g m i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> P F '-�mE - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" O E ` m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the oast of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- N m N T <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that his infor- fY7i V B O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to ha ` m <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> m i <br /> m <br /> SIGN HERE <br /> N: <br /> (signature of own or building tr or) (date) <br /> o <br /> ZONING ADMINISTRATOR <br /> NN N�+N<aN� Zt <br /> TOWNS PRM S MAY BE REQUIRED o N `8 N N S m <br /> 88888888 v) <br />