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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d M o to <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 H ° C� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c W <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. o <br /> N m_ <br /> OWNER WTEL.GEGPH2O(NNIdE m <br /> m f <br /> ADDRESSa7�o n <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) n <br /> CONTRACTOR R V1 !t/ <br /> TYPE OF PERMIT(S). DWELLING/BUILDING // �� GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> op <br /> STRUCTURE/ADDITION USE: R 00�«1l o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 'o <br /> o ° <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (yi), 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 -4 <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 9 �-- <br /> dated by the owner. (j 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o <br /> PLOT PLAN <br /> I <br /> t.11 S"o f N <br /> M <br /> /0 3a <br /> /y <br /> !3"Oea <br /> well <br /> N°i <br /> U�\" <br /> ° <br /> D De ZX y <br /> Mou �! d - � O ' <br /> � mmvmrn <br /> m ° Q,� O" nm � 33 <br /> mm <br /> CONDITIONS OF PERMIT c a z m o ° 3 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z mo `ter' i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° f ' Z' N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. nYrn f7 2 O <br /> 8 [ a c M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m `^ :I ' m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all inform a" <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. I <br /> g <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this t. I w ) <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. 3 8 i4 <br /> T ° Am : <br /> SIGN HERE <br /> m : : <br /> signature of o ae or Idin ntractor) i 5' C� �Iqn ; .�, ? � : x <br /> ZONING ADMINISTRATOR <br /> NSHIP PERMITS MAY BE REQUIRED JUN 1 2 1992 <br /> � <br /> 888888 $ 8vm, <br />