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0)'Yn N <br /> Burratt Cl;unty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � m o 0 <br /> r APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO TAE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 u <br /> regulations of the State of Wisconsin. — o <br /> w � <br /> m <br /> OWNERTELEPHONE FO <br /> a <br /> ADDRESS CT /0,0 C „� >v Zz" <br /> EMERGENCY/FIRE NUMBER _ f��s ROAD NAME <br /> 9" <br /> LEGAL DESCRIPTION (see tax receipt) <br /> ti� Z <br /> CONTRACTOR <br /> TYPE OF 7: DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION � 10 f. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° r-) <br /> STRUCTURE/ADDITION USE: A�� (7 L 6b <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc-) Z o <br /> 0 9 <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 (D17. .°r. <br /> 3. Show dimensions in feet ofthefollowing:(a)building to 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 M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a rn <br /> PLOT PLAN z <br /> c I <br /> SLS N <br /> �� 3Y <br /> f- — ! s<!sT[� <br /> 300 E— �PI, 1S 5cP7-C o <br /> 1 <br /> m <br /> Alva <br /> z <br /> �1 <br /> 55r 7s <br /> i <br /> A � �',�R'amm <br /> n <br /> 2 9 i� a eXJ <br /> CONDITIONS OF PERMIT: /`O S 3y.: G m' <br /> 1 .DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E .Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 21 y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �^ : m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o Sa C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all mforma- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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 which 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 county officials charged with administering county ordinances or other authorized person to havend1i <br /> 04 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. ^' b e <br /> ,Q 0 <br /> m mp <br /> SIGN HERE <br /> (signature of ow r or building contractor) (date) <br /> ZONING ADMINISTRATORm <br /> �. <br /> w re fe..rn ww1�rnT <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N 40 N N O N m <br /> 088000oom <br /> 0 0000041) <br />