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Bumett County 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Adminia Irator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS ' 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describiid and � u <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 _ <br /> regulations of the Stale of Wisconsin. �, m <br /> m � <br /> OWNER Z-, TELEPHONE O <br /> ADDRESS aO�O�V D (% � Y G' J�S'O Gl2�V Gu lS �� m <br /> EMERGENCY/FIRE NUMBERAlvd dd ROAD NAME 0~7V <br /> /`Q I <br /> LEGAL DESCRIPTION (see tax receipt) /7I <br /> Pc w Sw ro' a �j c <br /> CONTRACTOR S£(� �q{,(r it/ 4N �/Ile Y'H S = �✓ >"4`� L / y"d� kJ I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING P GARAGE/ACCESSORY STRUCTURE ADDITION >< o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> STRUCTURE/ADDITION USE: Om G� '� /� L:P er ON1k o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) J— ('1_ z o <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 (N),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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE tSSUED. 11 o N <br /> 71 z `c <br /> PLOT PLAN <br /> c � <br /> a <br /> /(/o2r'H Cr, <br /> o� Icre Oreef <br /> N <br /> T O <br /> V � <br />�♦ " , �- I <br /> \ VI o <br /> r � <br /> X im %c- <br /> V0 <br /> g <br /> _ , <br /> LeSs CK,) <br /> g 0m <br /> 9 <br /> CONDITIONS OF PERMIT: ^ w'j Q S -.0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 0 IQ : -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y E '• 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> f <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of y knowl- o <br /> ' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor. E p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ; $r$ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing this ap- <br /> plication. <br /> ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps n to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. T , 3 <br /> m $ a <br /> m <br /> SIGN HEREIM7 - a «+ <br /> (sig of own o llding con tor) I �IdI I _ i <br /> ZONING ADMINISTRATOR . g E E <br /> TOWNSHIP P MITS MAY BE REQUIRED II 2 6 I o N$N N m <br /> Ull� $ 8888888 M <br />