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( <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W ' $ c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr bed and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremei its of the a c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the aws and <br /> regulations of the Stale of Wisconsin. 6/Z-;3 -01 Z J ea ye Ytr��� a m <br /> W eexdr X66 aY�S <br /> OWNER (� TTELEPHONE n FO <br /> G <br /> YSG � � 7�' JwdeTL) /Q. JJ e. L m � <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) J 3Z 7- Z <br /> �C <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY ::)7- <br /> FILUNG/ARADING CAMPING UNIT SUBDIVISION o <br /> o �_ 1 <br /> / l N 0 <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z <br /> J <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 q <br /> measurement to the ordinary high water mark of lake, stream,or river. <br /> 4. If separate plans ar�Islubmltnt a 1 archi�tenct,engineer,builder,contractor,etc.,the plans must be si dated by the owner �W L A�� 0 <br /> NOTE: BUILDING/STRUCMUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. 7I v m <br /> Z o <br /> PLOT PLAN v ro ZrT L;Ug o 0 <br /> m <br /> 0 <br /> C = <br /> Q) - <br /> s Nut <br /> _ <br /> N (� <br /> 0 V I <br /> C e, <br /> �. <br /> (--II <br /> M r�4 0 10m —$ 2 a f�,m. M <br /> CONDITIONS O PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F : �� - - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. te <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 ; E ' 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- m Phtion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- }S B <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1 91 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication. I agree to permit county officiate charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> (JrLF? m <br /> SIGN HERE "1L�!�! <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �)` 8 - <br /> 8 [ <br /> TOWNSHIP PERMITS MAY BE REQUIRED T <br /> ' NN �NNNSm <br /> 88888888 ai <br />