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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Offke of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w 0<3 <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 �_ U <br /> regulations of the State of Wisconsin. <br /> w 0 c <br /> OWNERn TELEPHONE e <br /> �5G-,3 9 � a <br /> ADDRESS j K) / G ,3`✓ " 7 7-/(O`. 0( (�IKI'�`9r ` 2 - ALT (�2,O m <br /> / 7—� <br /> EMERGENCY/FIRE NUMBER �) ROAD NAME C-4�� In-n-•— �'4' <br /> LEGAL DESCRIPTION (see tax receipt) Aw y-y'/ _ C c+� _ �_ 7F- �� v_ /^_ p' f <br /> CONTRACTOR nA�_��Lit� r�r('"1 — & t�t uowl-'' mAr O / <br /> TYPE OF PERMIT(S): O�Y/It(V WHIDING_X— GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> n O <br /> SANITARY PRIVY�� FILLING/GRADING '� CAMPING UNIT ' SUBDIVISION o` <br /> / ^ r <br /> STRUCTURE/ADDITION USE: - - O <br /> Home/Cabin ommercial Business;B :Boom Deck;etc. <br /> z o <br /> 0 <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 drairlfield (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 M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAFFQ=•D FOR ONSffE VERIFICATION BEFORE A PERMIT CAN BEISSUED. 7I o to <br /> Z a <br /> PLOT PLAN ° a <br /> IIrF�- <br /> I v ° <br /> M (, < <br /> Al, ZI <br /> V & <br /> Z <br /> Jill <br /> u ( o {yv <br /> N y/ <br /> � 1 m <br /> v � <br /> 401 Iti� <br /> 2. <br /> O <br /> nZ <br /> a y(V � <br /> Ev58M:E M <br /> 2.�. a F <br /> m ]J g� aw &mom <br /> CONDITIONS OF PERMIT: < I.i `z S g t3' r+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F '0 i Vi i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i =r^i i 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" O 0 E ' m0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy ofI informs- N m�^ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that!this infor- iB p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providingl in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have 0: p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> N N <br /> SIGN HERE r ' �^ <br /> 1 nature o1 ow r or Wld g tort (da e)'. h <br /> C E E E E <br /> ZONING ADMINISTRATOR g <br /> NN4.: m <br /> TOWNSHIPPERMITS MAY BE REOUIRED' , L <br /> 4 `! i5 q m <br /> __l y <br />