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cm ccynP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS £ <br /> TO THE.ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m C <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 <br /> w � <br /> OWNERObef-L 'For-6-(L TELEPHONE o <br /> 111111 lIILLL //y�' <br /> ADDRESS IN PIQC4aC <br /> n ieeK Ct•0 6jW690 <br /> ec . RJ , <br /> 6 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> (�1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Ll'Y <br /> -> <br /> CONTRACTOR Arise,)— D l l r <br /> It <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> STRUCTURE/ADDITION USE: nl <br /> (Home/Cabin;arnmercial Business; Bedroom; Dyck;etc.) D <br /> Z o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) w <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions Infeet ofthefollowing:(a) buildingto all lot lines,(b)building to center line of road,(c)building 0 <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 <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 v m <br /> C <br /> PLOT PLAN o a <br /> M f11 <br /> cl <br /> A&ac f` PIS 4+J m <br /> I <br /> G o <br /> J <br /> N <br /> O <br /> J <br /> m <br /> O y <br /> N 111 <br /> w <br /> Z <br /> I 17 <br /> C 1 <br /> 2O_ c *2 r o a o m <br /> f <br /> M iii am == y <br /> CONDITIONS OF PERMIT: C8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 `z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i __r» <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. mo n n � p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o M <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- "1 a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- — 8 B g p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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- d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have [ m N 0 <br /> access to the above described premises at any reasonable time for the Purpose of inspection. <br /> T 3 gel <br /> 0 A N <br /> M N O <br /> SIGN HERE <br /> (signature of owner or building contractor) <br /> (date) <br /> �! o , <br /> ZONING ADMINISTRATOR to o;o rg E <br /> TOWNSHIP PERMITS MAY BE REQUIRED N m <br /> 0 000 U) <br />