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�'t corn�o, <br /> Burrett County 7410 Co. Rid. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w ' __ 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 'Z y <br /> located as shown herein. The u dersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use OrdinA ince,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wiscc nsin. <br /> N d r <br /> C <br /> OWNER t eS TELEPHONE - _ C� Le _a FO <br /> ADDRESS � �,, <br /> sa .� n1 <br /> ct�I �UI'IUl6t Sir f'QI,- I nth, S-7161 <br /> EMERGENCY/FIRE NUMBER �3 1 1 '3 ROAD NAME LK P <br /> LEGAL DESCRIPTION (see taz rec(ipt) 1 I `� L// _IS <br /> CONTRACTOR D Oj <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE _ ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION m O <br /> o L 0 <br /> ll� o <br /> STRUCTURE/ADDITION USE / �^1 IOYy +� e+— 0 0 <br /> Home/Cabin;Commercial Business; Bedroom; Deck; etc) v <br /> 0 0 <br /> o � <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 thew II (W), septic tank (ST), and drainfield (DF). 0 <br /> 3. Show dimensions in feet ofthe following:(a) building to all lot lines,(b)buifdingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. O <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. C <br /> 0 <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. m <br /> PLOT PLAN ?I o n <br /> M V_ y <br /> o 1 <br /> G <br /> W <br /> m <br /> m <br /> 0 <br /> ry <br /> o <br /> 0 <br /> 0 <br /> m <br /> O � <br /> N <br /> 13_ <br /> (I)r�l I CjrlitV <br /> I <br /> n _ 00a :E M <br /> CONDITIONS OF PERMIT: c < <.! c g =�. r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E o _Q <br /> 2. REMOVAL OR CUTTING OF REES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 1 NO GRADING OR SHORELA D ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ud'i v7 a: m <br /> 2 : ° a L' ` E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- �$ o : m <br /> edge and belief it is true,correct aid complete. I acknowledge that 1 am responsible for the detail and accuracy of all informs- «.y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be tali d upon by the County of Burnett Wisconsin in determining whether to issue a permit. Io m <br /> further accept all liability which m y 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 premises at any reasonable time for the purpose of inspection. <br /> 3 <br /> SIGN HER �+ <br /> (signature of owner or building contractor) (date) j « <br /> o <br /> ZONING ADMINISTRATOR 'C <br /> gg x <br /> x <br /> TOWNSHIP PERMITS MAY BE REQUIRED °o N N m <br /> boo o em <br /> 000 o � e y <br /> ea <br /> a <br />