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SurnertCCounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o c c <br /> APPLICATION FOR — LAND USE — PERMITS : <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desoribed and Q ji ° (� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and th a laws and <br /> regulations of the State of Wisconsin. o ---C <br /> b � <br /> C .eJ <br /> OWNER TELEPHONE _ D L� n <br /> O O o <br /> rt <br /> ADDRESS eIZ, p <br /> r 5YR9 -93 /3 I <br /> EMERGENCY/FIRE NUMBER ROADNAME <br /> LEGAL DESCRIPTION (seetaxreceipt)L�K <br /> CONTRACTOR 0 w} <br /> t3 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 0 ADDITION p Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 3 <br /> 0 <br /> 7 ec0 r <br /> STRUCTURE/ADDITION USE: � p'(L:�. /y� o o <br /> (Home/Cabin;Commercial Business; Bedroom;Dk;a .) <br /> 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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfieid (DF). r <br /> 3. Show dimensions infeet ofthefollowing:(a)bulldingto all lot lines,(b)building to center line of road,( )building .1 b <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. It separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s Igned and 0 <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o N <br /> PLOT PLAN (o may'1 I Mill c a <br /> 28' 1 Quer <br /> See A}N JM&A i cac��s� ( q�vy lot[ r <br /> t8 Show/ M )` <br /> See Llama, J. DRS <br /> �vr tit r-l5'Ser 1 � I,Ft'/n r i n <br /> TL) e eooezt o <br /> d <br /> Cd <br /> m <br /> O � <br /> O <br /> Z <br /> t � <br /> - <br /> f <br /> Arty <br /> DV u rLstl�C'�C� b'c 2. A a f m <br /> CONDITIONS OF PERMIT: c m 3. Q c S' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 4IQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N y <br /> -3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. irn : in <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- <br /> edge <br /> now)edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of II informa- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th this infor. 8 p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g"$ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe It to have ' <br /> access to the above described promises at any reasonable time for the purpose of inspection. �'• <br /> SIGN HE <br /> g ro of r or buildin <br /> ug contras r) (date) E « <br /> Pi <br /> ZONING ADMINISTRATOR $ <br /> N N n N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> m <br /> O <br /> 99888 $ U) <br />