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or� (Cfi�l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v <br /> 73- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Corse,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. �, m <br /> m g <br /> OWNER TELEPHONE a T)3 <br /> OOCC v ' <br /> � m � m <br /> ADDRESS 0 ' WIS „j�" G// 0MM <br /> �� <br /> EMERGENCY/FIRE NUMBER 17M/ <br /> ROAD NAME co v\ <br /> G 666 W1 1 (� . <br /> LEGAL DESCRIPTION (see tax receipt) A) �L I ) TYO N - R�7 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o It. <br /> o » <br /> ��11t <br /> STRUCTURE/ADDITION USE: � /[l[ <br /> (Home/Cab— iTrcial Business; Bedroom;Deck;etc.) Z <br /> 0 ° <br /> a <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 drainf laid (DIF). <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 signed and 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 <br /> PLOT PLAN <br /> Ztqo � P <br /> W <br /> IA <br /> o m <br /> o s <br /> o <br /> W y IaI IN <br /> 0 <br /> u <br /> o � <br /> N <br /> Z <br /> J <br /> 0 <br /> (on c -Pm oo aF <br /> m <br /> CONDITIONS OF PERMIT: = ? ,z Co 0 5, <br /> 1.1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ,i"n G] : m <br /> m � : O <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- c : <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 0, <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ e g <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 /> access to the above described premises at any reasonable time for the purpose of inspection. '. m 4 <br /> 4 ) m ' o Am . <br /> SIGN HERE X S ~ - tl ' <br /> (sign of owner r wilding contractor) (d e) [ a <br /> ZONING ADMINISTRATOR g ` ` - <br /> TOWNSHIP PERMITS MAY BE REQUIRED cine t3 r7n' N o m <br /> $ 8888 8 m <br />