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�� f( ccY,)Vj, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m v , z <br /> 0 a 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 described and .5 H ° J <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 <br /> regulations of the State of Wisconsin. <br /> N d <br /> N m <br /> OWNER XPI ^ L TELEPHONE 643q_ ] Q <br /> ADDRESS <br /> Q o <br /> t3oa S E;vF2�p�f1 <br /> EMERGENCY/FIRE NUMBER C GOp -? E)pSS JV, De F ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) IJ ' 1,•11_ <br /> /� Q <br /> CONTRACTOR y RRO� £F— <br /> TYPE OF PERMIT(S): ,DWELLING/BUILDING VVII GARAGE/ACCESSORY STRUCTURE_ ADDITION o —(- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o ✓ <br /> I� I . N r <br /> STRUCTURE/ADDITION USE: ���\t .J (0 o o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <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 North (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)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 X <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o <br /> PLOT PLAN <br /> )a X15 <br /> 1 � < <br /> C o <br /> t>,1 J <br /> N m <br /> OF Id, 1 <br /> ICO �D— s SE01ic y° �� <br /> m <br /> ° <br /> � o ws l I '. <br /> 9 � <br /> O y <br /> r Sqo ' + - <br /> J <br /> 11 <br /> M anon <br /> CONDITIONS OF PERMIT: m_ M S� 2 n m e m m <br /> Z. <br /> 2C� 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o': g Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° f—: <br /> ' ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rAii m <br /> c1 € m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this rmainfer- $' o <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 t. I ^ : ° o <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have a i til access to the above described pre ises at any reasonable time for the purpose of inspection. w'om <br /> T 3 09-: <br /> p m e A N ; <br /> SIGN HERE S - a� 13 �' ': '" g <br /> o : <br /> (sign tura o er Dull tractor) �! (da ) <br /> x' <br /> ZONING ADMINISTRATOR A g <br /> �. . <br /> T NSHIP PERMITS MAY BE REQUIRED o row N N w o Nm <br /> V <br /> 00000000m <br /> 0 0 0 0 0 0 0 0 N <br />