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L -4 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w f m o c <br /> APPLICATION FOR — LAND USE — PERMITS g' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ 1 <br /> regulations of the State of Wisconsin. w m 1 <br /> a o <br /> c <br /> OWNER TELEPHONE 7 _ y5_a -3SG�.— $ f <br /> Tc)fwv r1( c <br /> ADDRESS n p <br /> /`�D/ HE/C—if TS +t3GuD . . VV I (10(�c�fM l^I � S (6� <br /> EMERGENCY/FIRE NUMBER 1 94by r ROAD NAME /+O. V <br /> LEGAL DESCRIPTION (see tax receipt) LI Csm Ur 44 e '-7J l� <br /> CONTRACTOR <br /> �SeLF <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ✓ ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> STRUCTURE/ADDITIONUSE: GAKAeC agY,'Q 0 5 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <br /> 1 <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 Infest 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 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. am o Q) <br /> PLOT PLAN / Z <br /> / pM s <br /> 3IG C) _� <br /> 7/00 R <br /> YU <br /> � o <br /> ti <br /> U � Z <br /> CONDITIONS OF PERMIT: = ` Q c 8 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o io Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. H` i A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L �' i `• In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- '. <br /> ' t C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- }}+� y}!± : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- S S 75 ; t7 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue •permit. I $ $ <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- i E i i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized parson to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 'n <br /> M <br /> SIGN NERE <br /> s1p tura of ow r building contractor) (date) <br /> ZONING ADMINI RAT <br /> TOWNSHIP 061111111ITS MAY BE REQUIRED "S <br /> 88888 8 a) <br />