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uwBurnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Otos of Zoning Administrator W 'aO o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes <br /> ersig by application for a Permit for the work tlescrl and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer Is of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances end the I wr and c i <br /> regulations o'fnthe <br /> (State of Wisconsin. } y� 1z' 31 [1 D � 1 � <br /> OWNERsJT'CI.V C 1',1 I, t A' ,,�'p� TELEPHON� Sc-64/-i)---7 57'�l`L�1(/} 6�J O e� G� , £ <br /> ADDRES431�/I- � � + X\'3 �C0 Ur-i&V4- -N rmIJ SJ� IL1 i o F <br /> EMERGENCY/FIRE NUMBER d4,—1 L4 0 ROAD NAME -Co 5 j/o <br /> LEGAL DESCRIPTION (see tax receipt) S 1-3 „ 15 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION _ <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 -- <br /> ^� <br /> STRUCTURE/ADDITION USE:-P&46U(.�'nt'1 (,,}-, KI O illkm alfls o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z T <br /> 0 0 <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 Nort (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)Itullcling � I <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUS! BE TAi�D OR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o y <br /> PLOT PLAN Low �a � o n <br /> 5 too o <br /> ue C <br /> IIII ,1 ter. s <br /> � C <br /> t>J it <br /> C <br /> so' <br /> —� 241 <br /> b PfaQna� S'f a11' it 3 <br /> E- to' = a <br /> w' n 0Q <br /> Iy <br /> a <br /> � <br /> C� <br /> tmo (n <br /> g4 12,m m <br /> OA7> ��JLMa^� �� $ <br /> CONDITIONS OF PERMIT: NO <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. ', 9 � 5- :h <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r w p =w? E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. aJ@ vt : ; E m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of ny knowl- N o i . !E ' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- i •'m" T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion I 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 providing n this app ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ` p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> w <br /> SIGN HERE <br /> ( natu clown o ulld s contractor) L' ldate) 1 <br /> ZONING ADMINISTRATOR ' g f <br /> NN N+�NMNy Tt <br /> TOWNSHIP PERMITS MAY BE REQUIRED I!�i �� m <br /> t� �I� $ $ $ $$$ $8vi <br />