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.60 CbrYl p, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 It o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 l <br /> regulations of the State of Wisconsin. N o ylJ <br /> G O <br /> OWNER Yh be TELEPHONE X15O- <br /> m m <br /> ADDRESS rt!c(erf CtJ�s :541 ,939 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / 0-�- / &Hl <br /> CONTRACTOR e /, , <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o p <br /> M 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> a <br /> STRUCTURE/ADDITION USE: (2y`o LV., Y' M e S / ! -e <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) 2 <br /> O 0 p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I .` <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 are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSME VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o N <br /> PLOT PLAN S GLS /)•L��a' Av y /fA-1. 0 f <br /> /—l6 9_w v <br /> 'V a <br /> ,Yf &ot�ed A-re t In, 6e 9.�c1 c � <br /> N l <br /> II <br /> I)-l2/0 �tl �i� �� ��f-(��-r✓l or /�-�eG��1 fie« � <br /> f <br /> 62 SLPf ��� lir <br /> m <br /> S�aPe� y-o <br /> math P qrf� O'�7 �A k <br /> ✓✓✓ uti�4 l� t� s����� � -t�Ua-kes -��- cc,�frl�l�w_ ��� J <br /> 5-It-`P S -P <br /> v <br /> /� nrDDF <br /> A. g E a 0 a m <br /> CONDITIO OF PERMIT: Q 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 2Q .. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 19 RESTRICTED ALONG SHORELINE. �-�—N' i 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p' p <br /> $ : ig 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 informa- o m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I O <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- <br /> plication.I agree to permit county officials charged wi adminis ing county ordinances or other authorized person to have O N p <br /> access to the above described premises ata re n le ti f or the purpose of inspection. 3 $ m <br /> a <br /> m <br /> M u O : <br /> SIGN HERE E $ <br /> ( net of own uliding cont tog (date) 8 ; <br /> ZONING ADMINISTRATOR O: <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED NNN <br /> Nm <br /> $ 6 $ bNmS $ $ $ vi <br />