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F l J <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 1.-N' ('a 4� z <br /> m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3 <br /> TO TRE ZONING ADMINISTRATOR:The undersigned here makes Q X ° <br /> 9 by application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the L-� <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and a <br /> regulations of the State of Wisconsin. w m <br /> m 1 <br /> OWNER I, /A e S w TELEPHONE _./E <br /> h <br /> ADDRESS 13 rl)&L0'0CTJJI, LT: �,, 6�l�i n)l 55I��- <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> d n ell r)11 i1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE )< ADDITION p <br /> n L7 <br /> SANITARY PRIVY CAMPING UNIT SUBDIVISION o <br /> m <br /> STRUCTURE/ADDITION USE: GanOCa� 0 4 <br /> v <br /> (Home/ bin;Commercial Business;Bedroom;Deck;etc.) Z ii <br /> } <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 drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building 1A <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In 3 a, <br /> PLOT PLAN Z <br /> M o 0 <br /> D <br /> QC e�f m o <br /> C <br /> m � <br /> ) <br /> e <br /> N <br /> m <br /> n <br /> O <br /> N <br /> O <br /> b <br /> t7 y <br /> N <br /> IIZNI�J/\/``1\ <br /> I <br /> 0 N (n m <br /> lIN � DDp <br /> o c m m o n m <br /> D <br /> m � 0 � n m o N — D <br /> CONDITIONS OF PERMIT: � <. o SO 'o � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, O I O <br /> g i i s i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowlm <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- w 0.w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. Ig m 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- I <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have Op <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 R <br /> n n <br /> V N : <br /> N N A <br /> SIGN HERE VV H g <br /> w a <br /> (signature of owner u'I ng c actor) (date) s <br /> ZONING ADMINISTRATOR71 <br /> ` <br /> N : <br /> TOWNS IP PERMITS MAY BE REOUIREDN N o ui ooi� m <br /> a+ w s <br /> . tncnfn <br /> 8 8 8 8 8 8 8 8 N <br />