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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Offke of Zoning Administrator m : 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown Herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m _ <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and o '! <br /> regulations of the State of Wisconsin. e 9 <br /> {y� y c m <br /> OWNER D 1t14r N S D 1 Q le C 5 o IJ TELEPHONE h <br /> ADDRESS 1`1 (5 W�� � CCLitDr *,', 4o( b J <br /> EMERGENCY/FIRE NUMBER ROAD NAME 6.,st G O V�fJ Ctrs LAS , <br /> LEGAL DESCRIPTION (seetaxreceipt) 4' S35T a\bul A, •«� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> m r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z a I <br /> oi— <br /> } r <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and draintield (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 0 <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. Q e <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 rn <br /> 71 Z C <br /> PLOT PLANL o N tl or LIkk �� M c H <br /> 0 <br /> C � <br /> Q IMiI lU <br /> r <br /> rte, <br /> o <br /> �A c <br /> z <br /> SezStkta wlsc <br /> }�1 T1V I+ <br /> d� <br /> �nrDDF � <br /> fJ gEO�I'-�l d LLat Lina m $•� =' am0M <br /> o zcS" g' �_ <br /> CONDITION OF PERMIT: o F : C s - <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISS ANCE. Zh <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�r,; � In <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> L;': <br /> a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : o : <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 a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 1 iB i C <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ <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 descilbQKpiremises at any reasonable time for the purpose of Inspection. <br /> N <br /> SIGN HERE . <br /> a <br /> (sign re f owner r ilding contractor) ,__=.l�l•ta1:.- i. yq <br /> ZONING ADMINISTRATOR - ' ` g ' <br /> � awN�r.w <br /> TOWNSHIP PERMITS MAY BE REQUIRED o a' N i5 <br /> 88 .8 .N 8 8 vi <br />