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rrtcz�))> <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Vm o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes 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 m <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. N m <br /> A m Il <br /> OWNER /a y'1 ."/ TELEPHONE G /Z 3�,/ yC O <br /> ADDRESS '? <br /> Z-??!�a �c a�� /y� r>7n .S�o37 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> tom. 1 <br /> LEGAL DESCRIPTION (see tax receipt) L.a,P/ /� <br /> coo-E 1.3 sib TyoiLI izic .J <br /> i <br /> CONTRACTORC4dri-- <br /> 9 <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION o F <br /> O <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo <br /> 1� <br /> 0 - <br /> STRUCTURE/ADDITION USE: <br /> (Hom Cab rrrcial Business; Bedroom: Deck;etc.) Z <br /> 0 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 drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -1 ly-. U, <br /> measurement to the ordinary high water mark of lake,stream, or river. tr�`ilrlr <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. 11 3 m <br /> c <br /> PLOT PLAN o n <br /> M o <br /> M ) _< <br /> / I <br /> O <br /> J <br /> J <br /> N <br /> Z <br /> a <br /> I S <br /> f <br /> � c�oNi C>ao � <br /> m —gvs 2 m 4m m <br /> CONDITIONS OF PERMIT: o m S. CS '5' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 0 WZ —I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N = y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> '. N; ct2 : m <br /> o : a Lr D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o >a C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «.men; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inf - ,`a a . p <br /> motion 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 1 am providing in this ap- <br /> plication. Iagree to permit co my officials charged with administering county ordinances or other authorized person to have <br /> access tot above descri premises at any reasonable time for the purpose of inspection. m b m <br /> D m <br /> M O : <br /> SIGN HERE � ' <br /> (signature of w r o buildi ntractor) (date) ; i iMAY ' <br /> ✓✓ � . �. . <br /> ZONING ADMINISTRATOR <br /> off we Nd m <br /> TO NSHIP PERMITS MAY BE REQUIRED m m <br /> —J $ 'oorn <br />