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V/ 1 60ynr <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ' o c <br /> APPLICATION FOR — LAND USE — PERMITS — <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ibed and Q a <br /> located as drown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 0 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. o <br /> ��5� 38G-SIBS �o+ne <br /> OWNER o. j <br /> Bur 1<e � Do.v,d C. TELEPHONE (7Ys 2Sy-336 .Z m <br /> ADDRESS <br /> 1210 13'1 Y-c h Dir-, Fl jzo W r, S"/`6 16 liot, r <br /> EMERGENCY/FIRE NUMBER ? ROAD NAME <br /> J <br /> LEGAL DESCRIPTION (see tax receipt) S T I � Q <br /> AY <br /> CONTRACTOR T <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG CCESSORY STRUCTURE_ ADDITION p � <br /> SANITARY PRIVYo FILLING/GRADING CAMPING UNIT SUBDIVISION o --� <br /> ^ T <br /> STRUCTURE/ADDITION USE: G ai' o 0� <br /> (Home/Ca ;Commercial Business;Bedroom;Deck; etc.) Z ° <br /> 0 0 <br /> a <br /> a <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 Nor It (N). <br /> 2. Show the location of the well (W),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 <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 si ned and 9 <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 7I o m <br /> r 1A z c <br /> PLOT PLAN Sed ir�5 Fam QY1 Q� '�QC `ll"e �4.��' o n <br /> J M o <br /> C 1 <br /> 0 <br /> 01 <br /> I <br /> d <br /> 0 <br /> 0 I— <br /> O <br /> J <br /> O � <br /> 41 <br /> A <br /> ( <br /> Illygv/I__ <br /> NN F <br /> M c M r D aIn <br /> 0 <br /> CONDITIONS OF PERMIT: m Z c 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o0 . <br /> �z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> Art <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the Oast of my knowl- o : l <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- .+ro h m <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 permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providingin this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O a <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> T <br /> — m , <br /> SIGN MERE !I, <br /> (sigu of owner lamp contractor) ----Zdatej- - <br /> ✓;� [ <br /> ZONING ADMINISTRATOR &JAD ft I <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> m <br /> $ 88 $8888w <br />