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. ounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> f0 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describer and 9 w <br /> ocated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> 3urnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br />'egulations of the State of Wisconsin. <br /> m a I <br /> a O <br />)WNER / Reg r 61X,4 /10 L TELEPHONE __ IY U <br />\DDRESS as /SO Ci49 Li2- <br /> J <br />°MERGENCY/FIRE NUMBER o�. ROAD NAME <br /> W <br />.EGAL DESCRIPTION (see tax receipt) <br />:ONTRACTOR �- <br /> G� <br /> TYPE OF PERMIT(S): DWELLIN /BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 G7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> STRUCTURE/ADDITION USE: /\ 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <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). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)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 signs and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o y <br /> �_ Z `a <br /> PLOT PLAN ° n <br /> M vJ o <br /> u <br /> t, C <br />��J 1 <br /> J N <br /> � n <br /> 0 <br /> ° <br /> m <br /> O y <br /> aom <br /> S m M <br /> CONDITIONS OF PERMIT: < m': Q C S g' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �1,� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^' 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U1 i i O 9 i : m <br /> JO <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- o 0 !i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all it forma- rY «m•" m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that IN infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a rmit. I $42 $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in his ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person o have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> r <br /> SIGN HERE <br /> (signature of owner or bui Ing contras o (date) <br /> ZONING ADMINISTRATOR <br /> ✓ (irAww�w M. In <br /> TOWNSHIP PE ITS MA BE REOUIRED ':64X N i5 f5 m <br /> 888888 8 MU) <br />