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V <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54572 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri bed and o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer to of the c <br /> Burnalt Courtly Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I aws and <br /> regulations of the State of Wisconsin. m <br /> w <br /> OWNER TELEPHONE <br /> ADDRESS 67 ra n l >b L/YC GC4 54y / > <br /> EMERGENCY/FIRE NUMBER �a�S-3 ROAD NAME �f�-� I�C <br /> LEGAL DESCRIPTION (see tax receipt) H0 <br /> i(0 / -c^c 1 �� Lot iiOSnl i; P.?• f /of.e� CSnt t-, F'3 ) <br /> CONTRACTOR rn <br /> TYPE OF PERMIT(S): DWELUNG/BUILDING GARAGEIACCESSORY STRUCTURE X ADDITION o 1 v <br /> G1 �e <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION "' ° <br /> C. <br /> w � <br /> STRUCTURE/ADDRION USE: RL24r - o <br /> (Home/Cabin;Commeraal Business;Bedroom;Deck;etc.) _ <br /> o ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate Nort N (N). <br /> 2. Show the location of the well (N),septic tank (ST),and draintield (DF). or <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of rood,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. T <br /> 4. If separate plans ere submined by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and s <br /> dated by the owner. C) _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. 11 o O q <br /> c <br /> PLOT PLAN ? nff <br /> n <br /> / j <br /> L r r <br /> O y <br /> X �)J <br /> ds <br /> Z <br /> --------------- <br /> Jimf <br /> CONDITIONS OF PERMIT: ^� '• 6 ,� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <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 1 am responsible for the detail and accuracy of i ill Informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this Infor• -•' i b <br /> motion 1 am providing will be railed upon by the County of Burnett Wisconsin in determining whether to Issue I permit. I ? $ <br /> further accept W liability which may be a result of the County of Burnett relying on this Information I am providini in this ap• <br /> plication.)agree to permit county officials charged with administering county ordinances or other authorized pen on to have , _:J <br /> secs"to the above described promisee of any reasonable time for the purpose of inspection. <br /> _ <br /> I�i i <br /> m r <br /> fi i i <br /> SIGN NEREI, <br /> (signaretuf ow6or on building contractor) ��] _ .(Qttt <br /> a <br /> ZONING ADMINISTRATORI�n <br /> TOWNSHIP OiRMITS MAY BE REOUIRED MAR 2 Z 11514 <br />