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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C9! C- o ' o <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 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Ac <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 /> N � <br /> m Q <br /> OWNER _ / $ / TELEPHONE <br /> ct a/ ri M <br /> ADDRESS .�rJ4 G G1^SIO <br /> EMERGENCY/FIRE NUMBER �f h `6 / - ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> s �. -e <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> I <br /> o L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONa ° <br /> STRUCTURE/ADDITION USE: " /O X 7 { %✓4 r'r7 o <br /> oma/I- C�ab�n,Commercial Busmess; BedTOrnmBeelr, eterr, — Z o <br /> 0 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 drainfield (DF). -2 <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto 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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a mQ-) <br /> PLOT PLAN Z 0 <br /> o a <br /> � s <br /> 0 <br /> — -- -- — ----- - c <br /> 411f 0 <br /> t <br /> I o <br /> 1y j IQ <br /> I O <br /> rrain�; z / c° � <br /> f � � <br /> I <br /> s <br /> 1j 2O,c�wrr0 nim <br /> M. 2. Mgm <br /> D g� lu aye— 37 <br /> CONDITIONS OF PERMIT: is Z c$ 50 no T+_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F c i E Fm <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y: M <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I P, D <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl-I 0 - �' <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa-I m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this in r- o a p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I , 0 <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 O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> 3 <br /> m ap m <br /> m <br /> N O <br /> SIGN HER f• "�" . -'7 - �C�— 3 N <br /> (signatt� ,Fdi Dufld' g contractor) 1 <br /> A8 Vis: € <br /> ZONING ADMINISTRATOR ' 8 ' <br /> TOWNSHIP PERMITS MAY BE REWIRED o 0 0 0 0 0 0 o m <br /> 000000000 <br />