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Burnett Cotity 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o a <br /> APPLI ATION FOR — LAND USE — PERMITS 3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The ur dersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinarice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. h m° <br /> N R <br /> n 10 <br /> OWNERr Cti 71- TELEPHONE ��a _ y�3 _ 9 9 y I £ <br /> n r-r o ' <br /> /� � / m � <br /> ADDRESS Id-7,3 (a d_✓OVec" 4br, ✓Q / /A V <br /> Ie 0, Ie / , <br /> ,Q '1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME C e �l Q ot C/ ; m. <br /> LEGAL DESCRIPTION (see tax race pt) a Co T 'VO / L�J L.07/ _ <br /> S/''1 ✓iy es z� � ` <br /> CONTRACTOR <br /> TYPE OF PERMIT(S). DWELUNG/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION O m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONa ° `CO� <br /> STRUCTUR DDITIO USE: -bcck"- ° o E <br /> Home/Cabin;Commercial Business,Bedroo eck; tc.) Z vo -� <br /> O 9 <br /> N <br /> 1 <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 thew II (W),septic tank (ST), and drainffeld (DF). o <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building -1 <br /> measurement to the ordinarf high water mark of lake,stream,or river. <br /> 4. If separate plans are submi ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and - <br /> dated by the owner. <br /> 00 <br /> NOTEBUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> c <br /> PLOT PLAN 7 ' [ a ( A o n <br /> m I ;' <br /> 0 C <br /> Dec \D V <br /> 2 E8 <br /> 75' yam 30' Su <br /> I N <br /> 0 0 <br /> N � <br /> J <br /> \ /00 f <br /> a 0 <br /> �a <br /> Z <br /> �r <br /> a Jr$ <br /> �c -00 a010 <br /> Of <br /> CONDITIONS OF PERMIT; f� ? m y. C8 O <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHI S OF PERMIT ISSUANCE. c £ 0 . <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION RICTED ALONG SHORELINE. =2 >7 <br /> 3. NO GRADING OR SHORE ND ALTERAT ALLOWED UNLESS SPECIFICALLY PERMITTED. c Ona: p <br /> I declare that this application(ir cluding any accompanying schedule)has been examined by me and to the best of my knowl- wio C <br /> edge and belief it is true,correc and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- .n y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0 m <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- y, <br /> plication.I agree to permit cou ty officials charged with administering county ordinances or other authorized person to have i OuNi 0- <br /> access to the above described remises at any reasonable time for the purpose of inspection. 3 0 P, <br /> : v <br /> m <br /> m <br /> S' 9 S _ '" . <br /> SIGN HERE - - <br /> (si n re o wneror g contractor) (date) n <br /> ZONING ADMINISTRATOR i <br /> a <br /> X, <br /> k �K <br /> J� N N T <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 NN u, <br /> ov m <br /> ob o m <br /> 000 0$ (n <br />