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ort cel <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 <br /> TO THE BONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and <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 Ordi iance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wis onsin. <br /> / m —moo <br /> OWNER I r I� , la -C I 7 /Q�' TELEPHONE <br /> �n — 7/ a v <br /> 11 p r <br /> ADDRESS S/ ' 1.N ,.. )0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME /-/V- <br /> LEGAL <br /> AMEH/w-LEGAL DESCRIPTION (sae tax r ceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELUN /BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p Ci <br /> n _ j <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> I11 <br /> 0 <br /> STRUCTURE/ADDITION USE: pt o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or tap 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 ell (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet o the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordin iry high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are subn iitted 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 LC CATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT41N BE ISSUED. 7I a to <br /> PLOT PLAN ,(� OI /3W✓1 �•`^ crib' Z <br /> /1 o a <br /> toC.�T M <br /> In <br /> > �v ' <br /> y , <br /> o <br /> +° o <br /> W � <br /> I ��0 z <br /> It,4L <br /> Moved (:�bl`rL I � <br /> 2F rn <br /> 22. e= rn <br /> CONDITIONS OF PERMIT: w : Z c 8 .o-0 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F it <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M <br /> H <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ni: m <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- '^m o: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ig <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 oo <br /> further accept all liability whi h 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 co inty officials charged with administering county ordinances or other authorized person to have 0 N p <br /> access to the above describe premises at any reasonable time for the purpose of inspection. m ; 3 0 <br /> AApp H <br /> M . O . <br /> SIGN HERE LCi� c _._ : - <br /> a: B <br /> ( ig ure f owne or I g contractor) (date) <br /> dd <br /> ZONING ADMINISTRATOR <br /> g <br /> TOWNSHIP PERMITS MAY BE REQUIRED NOV <br /> 00000005rr <br />