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07) C , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m of O <br /> APPLICATIONFOR — LAND USE — PERMITS3. <br /> W d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Z 5 <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 <br /> regulations of the State of Wisconsin. H <br /> OWNER TELEPHONE /_( 7/.5 L�L� �—/ y�: <br /> ADDRESS ` . 3/�' C, _S �lI �'� f:/Z L�c,�F CCS"/, 7 Z b {�- <br /> EMERGENCY/FIRE NUMBER 2 3 ROAD NAME �C &`/ ' <br /> LEGAL DESCRIPTION (sae tax receipt) (O A) �e S f"� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING//BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> � L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> �+� <br /> STRUCTURE/ADDITION USE: J G'�P` CT, G � 2a- )( 30 <br /> 0 0 <br /> (Home/Cabi ommercial Business;Bedroom; Deck;etc.) Z o <br /> O O <br /> N <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 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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o N <br /> PLOT PLAN A'/� �� T r A o <br /> � n <br /> Co ISG( r� �rD 6Sa� o Ct+'� 411 <br /> E a <br /> m <br /> t,. <br /> _ 0 <br /> -- — o <br /> m <br /> N <br /> Z <br /> X <br /> Ac< 01 a*m — L.* 2.am &e M <br /> S: <br /> CONDITIONS OF PERMIT: <br /> g mzc� �� � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V i O 0 : i m <br /> gii L2 <br /> mB C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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 : a m.n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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. I oo <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- `n <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at spy reasonable time for the purpose of inspection. r ; 3 'oo <br /> m AAp N <br /> C : <br /> : <br /> SIGN HEREZ7; c <br /> (signature of ow er dildi V ( te) � <br /> ZONING ADMINISTRATOR S <br /> TOWNS IP PERMITS MAY BE REQUIRED o N N N N N m <br /> rn <br /> 000 0 ii 0 N <br />