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Burnett.County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Administrator U) m oOZ <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 o <br /> regulations of the State of Wisconsin. `" <br /> N <br /> n O <br /> OWNER TELEPHONE 448(6ARe(1M _ � <br /> ADDRESS +I444 POYV0_V,,A PJ4c Sa IMrN -S'34-q-3(-qJ <br /> (� t <br /> EMERGENCY/FIRE NUMBER 011 {� ROAD NAME S(]mA W(.0 Q0 C_CX <br /> LEGAL DESCRIPTION (see tax receipt) S 4,'4 ft'to/atso eircoPS r `a FI .-v Lwi•a r oxom 1n <br /> CONTRACTOR 1b0r*ULHAj0 OM% QJUI,L-1 CQ' fl-0 c '1AII <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE CESSORY STRUCTURE ✓ ADDITION _o <br /> n <br /> 0 <br /> /7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o �_ <br /> 6" w r <br /> STRUCTURE/ADDITION USE: B" " c�JLTtY'C�QP v o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> 0 0 <br /> m <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). g <br /> 3. Show dimensions in feet 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. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a y <br /> 7I Z `v <br /> PLOT PLAN m <br /> 0 <br /> 041-41 (Co4w'I <br /> d <br /> I <br /> n <br /> 0 <br /> N IXJ <br /> O <br /> 0 <br /> (J II�yVv�J�/j <br /> I <br /> Z <br /> G <br /> A O,c 3 W g 0 a.f M <br /> n m M <br /> v m�� 9C o.9. <br /> CONDITIONS OF PERMIT: o F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. I _M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. " <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. un m <br /> o if C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best 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- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 0 <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. N <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. T <br /> al m A N <br /> O <br /> SIGN HERE � Ms <br /> — �^ <br /> (signature f owner or budding contractor) (date) o x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N J N N u N m <br /> 0 0 0o0 o0 tli O rTl <br /> oboo0 <br /> 00000000N <br />