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M cbRp , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c m o 0 <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 Q m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 c <br /> regulations of the State of Wisconsin. y <br /> OWNER r)/1l //M i-- 1 (��¢ _ 1 TELEPHONE /9 q n O <br /> ADDRESS D <br /> P, L 13 <br /> EMERGENCY/FIRE NUMBER i L --J ROAD NAME �Z J <br /> LEGAL DESCRIPTION (see tax receipt)�`1/ a•/B \' <br /> 3 / S <br /> �L X 38 /S. os O 30o L a�� C?SlYJ ✓ 8 f� <br /> CONTRACTOR GCI.-�l' LO? SI 7S <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 9_ ARAGE/ CCESSORY STRUCTURE ADDITION o <br /> n L) f'J <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° (� <br /> o <. <br /> _ H G <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <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). <br /> 2. Show the location of the well (W), septic tank (ST),and drainfieid (DF). 5 <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building q <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 2 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a m <br /> PLOT PLAN o n <br /> m <br /> -- - ----- <br /> c � <br /> M <br /> � ail <br /> L <br /> I 0� <br /> 1 <br /> I <br /> i <br /> /rte Z <br /> -- , <br /> o <br /> m <br /> CONDITIONS OF PERMIT: J3� C ` m g� Er <br /> C ° m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a N >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> -0 gE : O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- u a a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `� of o ; p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I b g o [ <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 have <br /> 0" o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 01 b m <br /> ` a Q 0RL <br /> SIGN HERE <br /> (signature of ner orbu 1n cont (date) <br /> o : z [ <br /> ONING ADMINISTRATOR S <br /> u> T <br /> TOWNSHI EMITS MAY BE REQUIRED O N UN N N N m <br /> o $ $ $ 000m <br /> 0 U) <br />