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CM <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admidistrator um o 0 <br /> APPLICATION FOR — LAND USE — PERMITS - 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° C—n <br /> Ig try application for a Parma for the work tlesc ibed and w �� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem ms of the W Cc <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. w m <br /> c m <br /> c <br /> OWNERI)OtA TELEPHONE £ <br /> o <br /> ADDRESS Z/ Q31 C rl EL a D , b�E85fER 1�II . �`I'893 m <br /> EMERGENCY//FIRE NUMBER rl ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> I� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY_ PRIVY FILLINGlGRADINGCAMPING UNIT SUBDIVISION r' o <br /> o <. <br /> a <br /> STRUCTURElADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> Z o 1 <br /> o v <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 No h (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 at ned and 0 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 7I 3 y <br /> PLOT PLAN Z <br /> o a <br /> C _ (� <br /> �fl��-4E0 m <br /> V1 <br /> G <br /> a <br /> _ <br /> s <br /> _ <br /> O y <br /> w <br /> (�\ M <br /> 1 <br /> 9 to-0 <br /> 5[[DD*m <br /> CONDITIONS OF PERMIT: w ,z C W g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE, a se : : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =ti M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> g, 1 iJ 2 . ' 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 ill informs- i <"m H i T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B G <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I ': $�$ 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing m this ap- ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. ro [ a <br /> SIGN HERE "•"^"^ , �'r - h <br /> ( (date) <br /> i <br /> ZONING ADMINISTRATOR $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED { N N g m <br /> $ 8 $ 8 $8 M <br />