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OM&W, <br /> Burnett County 7410 Co. R 1. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N a o 0 <br /> APPLI ATION FOR — LAND USE — PERMITS s _ <br /> m ° <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and v 8 <br /> located as shown herein. The un 6migned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinat re,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wiscon ain. m <br /> w ,T <br /> OWNER I 19691 fZ TELEPHONE 61,,2 V,7 a ya/ O � f <br /> _ m <br /> ADDRESS T• 9s'r.•� /�� Jai e <br /> EMERGENCY/FIRE NUMBER 02 ROAD NAME(13 4201' OF <br /> LEGAL DESCRIPTION (see tax recoil t) E riff / -W O R <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BIJILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> � w <br /> STRUCTURE/ADDITION USE: <br /> (I Aome/Cabin;Commercial Business;Bedroom; Deck;etc.) Z a <br /> DIRECTIONS FOR PLOT PLAN )RAWING: (Aerial or top view) <br /> ° 3 l <br /> 1. Show the location and size i f all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the we I (W),septic tank (ST),and drainfleld (DF). o <br /> 3. Show dimensions In feet of t following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarl high water mark of lake,stream,or river. <br /> 4. If separate plans are submitt id by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCA FIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 v m <br /> c <br /> PLOT PLANeet °° <br /> C ° i <br /> � a I <br /> I� <br /> 0 <br /> la <br /> 30 <br /> 3 iso' <br /> m <br /> o <br /> I <br /> Y <br /> ©bar gaG t To Arvy <br /> CONDITIONS OF PERMIT: Q Z Z g ?r� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2, REMOVAL OR CUTTING Of TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Gt G <br /> i <br /> I declare that this application(in luding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> Er e <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 applicatio (Including any accompanying schedule)and I further declare that I recognize that this infor• <br /> motion I am providing will be Had upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; $ <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit coup y officials charged with administering county ordinances or other authorized Person to have <br /> access to the above described I iremises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE Z— <br /> I un of r ding contractor) (date) - <br /> ZONING ADMINISTRATOR <br /> q $j <br /> TOWNSHIP RMITS MAY BE REQUIREDo ' i5 !Jr'14 m <br /> l8 $ $ 8$$i88 rn <br />