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� l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adr�tinistrator m o 0 0 <br /> �_ z <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as Shown herein. The undersigned agrees that all work shall be done in accordance with the require Inents of the m = rJ" <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and I he laws and �_ <br /> regulations of the State of Wisconsin. H m <br /> m et <br /> t� a ° <br /> OWNER cher TELEPHONE 653 -a3a o <br /> ADDRESS aaaa0 Ootid Crcc 1 Rd- J 1 rie 111 WZ <br /> EMERGENCY/FIRE NUMBER d 3a a 0 ROAD NAME OQod Cree <br /> LEGAL DESCRIPTION (seetax receipt) S'� J <br /> _ c^� -SCJ Sec aT33 ?N- R I f IJ <br /> CONTRACTOR — <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> L7 <br /> SANITARY PRIVY FILLINGlGRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> r " r <br /> STRUCTURE/ADDITION USE: 1 V ao <br /> (Home/Cabin;Commelicial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> 9 <br /> m <br /> 3 <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 lorth (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of thefollowing:(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 b signed and M <br /> dated by the owner. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUE 11 - N <br /> PLOT PLAN r o n y <br /> it <br /> � o <br /> ❑ a ! <br /> �gtvy n1 <br /> uu <br /> er7n <br /> lu 3o I <br /> I�KP= N�&rn49 ofJrre�Q�� <br /> �+ " 9 J <br /> m <br /> A fi,aK <br /> �DIW SaPf` , <br /> IJcll o. ICK <br /> A6 + <br /> I H' z <br /> Dome p <br /> R, <br /> p vlJ <br /> 23�a I f <br /> ITIVE <br /> a v Wr>> 1 <br /> IONDITIONS OF PERMIT: m 3. S E W 3 <br /> 1 .DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a £ . - 'R <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -- �',— _7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the bes of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ` «O« <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize hat this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to iss tie a permit. I <br /> D Y Y Yrelying P g p <br /> further accept liability which may be a result of the Count of Burnett on this information I am rovi in In this a <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized w <br /> arson to have E °. <br /> access to the above described premises a reasonable time for the purpose of inspection. t <br /> T <br /> o <br /> SIGN HERE <br /> (signature of owner or building contractor) 1 at I <br /> ZONING ADMINISTRA <br /> TOWNSHIP PERMITS MAY BE REQUIRED o r <br /> 08 88888 i' <br />