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1 04 0:%fy' <br /> Burnett County 7410 Co. Od. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and H o <br /> located as shown herein. The L ndersigned agrees that all work shall be done in accordance with the requirements of the mm <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. - <br /> w m ' <br /> m <br /> OWNERCgo Prrt-RsoaTELEPHONE n <br /> ADDRESS /Sq:3m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax ret ipt) Ji - <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p T <br /> \ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> N <br /> STRUCTURE/ADDITION USE: T 1 �1T-� 8 <br /> (Home/Cabin; mmercial Business; Bedroom; eck;etc-) Z 0 <br /> co <br /> v <br /> U ` m <br /> DIRECTIONS FOR PLOT PLA 4 DRAWING: (Aerial or top view) V <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 m ell (W),septic tank (ST), and drainfield (DF). <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 CU <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 UI <br /> 4. If separate plans are subm fted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X _ <br /> dated by the owner. 0 0 .� <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I M cn er1 <br /> c N <br /> PLOT PLAN o a 7� <br /> M <br /> C I _ <br /> �1fi��HEo M <br /> to c <br /> �y V <br /> r <br /> G�d o <br /> 7',C <br /> N o <br /> 0 <br /> !VIS <br /> a <br /> i. <br /> M bnN V�nrDDO <br /> m g c� '- am of m m <br /> CONDITIONS OF PERMIT: <br /> < m':0 . .z C80ri � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =y 37 <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : 25 2 i m <br /> � � i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my L�knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- a�>: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ii; o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 big 0 <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have _ ON m <br /> access to the above describedl premises at any reasonable time for the purpose of inspection. <br /> Wit. 1 00 <br /> r- <br /> - n m i <br /> SIGN HERE (6*aAffijtJM lill^WPa&OF h.1-Inif so a, (date) <br /> - o : x <br /> ZONING ADMINISTRATORMAY � ' S <br /> ��� -n <br /> TOWNSHIP PERMITS MAY BE REOUIRED N N 4 N N N N m <br /> N u' 00 <br /> 000000 0 (/) <br />