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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator En m o e <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 42 N --- <br /> located <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the '4 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. y Q <br /> w � <br /> c <br /> OWNER / /•/1�0 / / "T � S` TELEPHONE C o O <br /> ADDRESS/3,r '.0M/5a.✓ T✓ `� _� <br /> EMERGENCY/FIRE NUMBER .;Z)/3 <br /> J / ROAD NAM/-E _J— <br /> LEGAL <br /> .l)%�N <br /> LEGAL DESCRIPTION (see tax receipt) Jl. <br /> N/ L <br /> CONTRACTOR -Se CF <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: �ap i //d <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> o ° <br /> v <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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dreinfield (DF). I o <br /> 3. Show dimensions infeet ofthefollowing:(a)bulldingto 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 M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a w <br /> PLOT PLAN o o a <br /> o <br /> 93 h "f �Id•D) 4 . <br /> k1/ol , m <br /> � l�` � ?G rj�clG Gxid <br /> moo" <br /> M <br /> As�K I. <br /> o <br /> 6` <br /> N <br /> y � <br /> t*ti�aG7 yO ~ <br /> .I • I l <br /> 8 � <br /> rni a� 'D <br /> T O �✓ RC� `°° D�� � am emy <br /> CONDITIONS OF PERMIT: �.l I � �s' q y. Q CS n r. <br /> 1. DRIVEWAY MUST MEET DRIV AY WIDTH REQUIREME ITHIN 60 DAYS OF PERMIT ISSUANCE. oF 0 �Q <br /> 2. REMOVAL OR CUTTING OF T EES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - -N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ise 9, : O m <br /> 'ti of aL' Q <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- is $ p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o 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" 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 0 0 <br /> m 0 A N <br /> 111 M Nps <br /> SIGN HERE <br /> ds <br /> (signature o er or bu' inc tract date) ; �+ <br /> o xE <br /> ZONING ADMINISTRATOR /� o <br /> -n <br /> TO <br /> TOWNSHIP PE MITS MAY BE REQUIRED o N N . 0 <br /> N m <br /> 00000 ooy <br /> i <br />