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f)�% 6M�0' <br /> Bumett Count( 7410 Co.'IRd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ n <br /> regulations of the State of Wisconsin. - <br /> m <br /> N � <br /> C <br /> OWNER S�F-Gu . / Ze I / TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER 3c� 7 C ROAD NAME <br /> LEGAL DESCRIPTION (see tax re eipt) A'l 1 E L T-39' - i y w LP <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN /BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION W p <br /> n 0 r <br /> SANITARY ' PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION - 1`r <br /> o < L <br /> STRUCTURE/ADDITION USE: o ° <br /> TO <br /> (Hom Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> a <br /> l m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> j�CIJ ' <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 of thefollowing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building 0 <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 p <br /> dated by the owner. () <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I c m <br /> c <br /> PLOT PLAN A o a <br /> C <br /> II_� <br /> N � <br /> ° IJ(y <br /> J <br /> J <br /> 0 <br /> 0 � <br /> N j <br /> Uv <br /> Z <br /> 11III� <br /> I <br /> 3 O,c-0N rn a0 a <br /> M <br /> m, <br /> CONDITIONS OF PERMIT: � 0� m. ,z CS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c F 5 �Q :1 <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i =y M <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Mi i O o : m <br /> I declare that this application Including any accompanying schedule)has been examined by me and to the best of my knowl- o i C <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 a 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. 1 <br /> further accept all liability whit i may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit COL my officials charged with administering county ordinances or other authorized person to have i 0 m <br /> access to thea ve descri pirmi:T at any reasonable time for the purpose of inspection. <br /> i i m A 0'i <br /> HERE <br /> (signature of owner or building conthkown L9 tj5 0 <br /> "NISTRATOR <br /> `n es ua a 'T1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED f �C� N N N m <br /> 0 0 000ai <br /> l <br />