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Hyl C( �')AID, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n Z <br /> regulations of the State of Wisconsin. y v <br /> w � <br /> m O <br /> OWNER ` r w,/J 1 r / TELEPHONE /;S /Sy n <br /> ADDRESS 2- <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 0 y-r� �p <br /> LEGAL DESCRIPTION (see tax receipt) Sc.. L3- 7 '2/S A�.$ `�`/�( Z -Sl `/ /O i"1 �`�4 <br /> CONTRACTOR YT` <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ L--`ADDITION p O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> QQr <br /> STRUCTURE/ADDITION USE '�Cl(�G.r� aUr �C � o ° <br /> (Home/Cabin;lCommercial Business;Bedroom;Deck;etc.) Z o r <br /> 0 0 <br /> m <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 (D17. <br /> 3. Show dimensions infeet 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. <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 1I 3 m <br /> c <br /> PLOT PLAN o n <br /> M I� <br /> 'Zi? <br /> m <br /> JJ <br /> l <br /> r Q <br /> 7LV- <br /> cc N <br /> 0 <br /> z� <br /> �ll, •VY�, .� I3MG� <br /> on ,v <br /> m CM.0a0 aOmIT <br /> 'O <br /> m —g� NQ <br /> � <br /> CONDITIONS OF PERMIT: m N: Q C8 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. S N t7 2 m <br /> 0 : n8 O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. 1 o' _ m C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs. rn m a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- B g Cl <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $'$ $ <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 <br /> access to the above described remises at an reasonable time for the purpose of ins `" - <br /> P Y Do inspection. r <br /> SIGN HERE7 rtbsn. [5 ;' 4 Pow <br /> V (signature of owner or building contractor) - <br /> C o : <br /> ZONING ADMINISTRATOR --J"� r (�'�l <br /> �. . <br /> TOWNSHIP PERMITS MAY BE REQUIRED o(n N u,N N m <br /> 000000000 m <br />