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el) e <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the N `m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. - <br /> m m <br /> OWNER "/E�Q r/' �- _511,1//U�&A) TELEPHONNE1 '/2^—�qq 11696 a <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME00 <br /> t <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: Cj� (}C / G O/– �-0�K 2B' o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z 0 <br /> P ° _— <br /> L <br /> a <br /> m ^ <br /> 3 UTJJ <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 drainf laid (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 .1 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 a ur <br /> PLOT PLAN !` M A S l/ f)/QEH o a <br /> - - M <br /> 0 <br /> C <br /> c <br /> <a <br /> l� e/ <br /> 4 1 <br /> n <br /> I <br /> N <br /> 0 <br /> I m <br /> o <br /> i <br /> I I O <br /> /d0/ tit <br /> tz <br /> 1e 5 <br /> Xp <br /> r l 2 <br /> ) — 300' �� I m O.cMmrDDaO -0 <br /> m Dg� 2. 0 L <br /> CONDITIONS OF PERMIT: ? y. Z C8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =m M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. bmi i m <br /> o p l is [ D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 'i o i m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- - m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- (}�-�9 al p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I l.', Q <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 with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. r S <br /> m a <br /> SIGN HERE <br /> (sign re of o ner or building contractor) (date) <br /> ZONING ADMINISTRATOR pIJ)opt S <br /> TOWNSHIP PERMITS MAY BE REQUIRED O Nn N N VN .0" pN m <br /> S S S S S S S S N <br />