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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to '1 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS _ f <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w ° <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 Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the,laws and <br /> regulations of the State of Wisconsin. — 5 <br /> OWNER _UG ,,//1O X � TELEPHONE a S� 7(Z A n I� F <br /> ADDRESS �/ Y�d S ICI ( c j3 rUE L(j-Kt � IA't.iBJr`..f 830 <br /> EMERGENCY/FIRE NUMBER ROAD NAME A-t. r— - l41C ' <br /> LEGAL DESCRIPTION (see tax receipt) "T (- C'-S I(,{ 1 <br /> 3( (g �� tL-2-r -95! r UoL. <br /> CONTRACTOR rn <br /> 1 cftez�'v7— ,Z 9 7-7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION 0 <br /> STRUCTUREIADDITION USE: 4741 e c�491ol <br /> g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> 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 (DF). o <br /> 3. Show dimensions Infeet ofthefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,( 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 0 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> PLOT PLAN Z `v <br /> o n <br /> SES RT�—,4f e+e✓—D M <br /> m !0 <br /> -C <br /> L <br /> {Ti N <br /> J 02 <br /> O ' <br /> o <br /> m <br /> 2. <br /> v � <br /> N <br /> J Z <br /> i <br /> f <br /> CONDITIONS OF PERMIT: q m 3.: cc. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '• N m <br /> � ' O <br /> I declare that this <br /> 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 Oil informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> matlon 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.1&orae to permit county officials charged with administering county ordinances or other authorized person to have <br /> 0: r, <br /> access t0 the scribed p s y reasonable time for the purpose of Inspection. r 3 3qF <br /> SIGN HERE <br /> (signature of o er c r Id o c n rqtto <br /> - `Idaaf- <br /> I <br /> ZONING ADMINISTRATOR78 <br /> $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED , o N$N $ <br />