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Burnett County 7410 Co. I Id. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLI ATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the Work described and � c <br /> located as shown herein. The u dersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordini nce, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0 <br /> regulations of the State of Wiscc nsin. y m <br /> w � <br /> OWNER I 1 a TELEPHONE '- �a _ /�/, Cif _ 6n 3_� m y� <br /> ADDRESS J !�. C"' � u� 'f1l- <br /> S.W. Eros <br /> EMERGENCY/FIRE NUMBER •fJ1 ' ( ROAD NAME gushQUj r C� <br /> LEGAL DESCRIPTION (see tax reci ipt) <br /> CONTRACTOR Geo r e -B Q w (\ <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ o �\ <br /> n L7 ( ) \ <br /> SANITARY PRIFILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> PRIVY <br /> � r V <br /> STRUCTURE/ADDITION USE: i U i !a+ [3016 07 o <br /> (Home/ bin; Commercial Business;Bedroom;Deck,etc.) 2 v <br /> 0 0 <br /> 0 <br /> � W <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 (NS) and Indicate North (N). <br /> 2. Show the location of thew ell (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of he 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 signed and 9 <br /> dated by the owner. 0o <br /> NOTE BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a N <br /> C� n 11 Z <br /> L Gl�< See /� O a <br /> PLOT P N-- a n <br /> M0 <br /> $`4 C <br /> m . <br /> - _j -, b <br /> N.a liar �� <br /> E. <br /> ' Weil G cn <br /> a C! L3 F ,((jraernen� 02 0 / <br /> oOro <br /> I\V1 0 <br /> o � <br /> 3 1a __ Z <br /> -W cgA <br /> o� <br /> m a = d a m a m m <br /> < W: � T <br /> CONDITIONS OF PERMIT: < `� 0 m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAY6 OF PERMIT ISSUANCE. o ,m F .'2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^' <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N�gO n m <br /> a O <br /> : - C <br /> 1 declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «r m'^: T <br /> lion contained in this applicati n(including any accompanying schedule)and 1 further declare that I recognize that this infor- i p <br /> mation 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 whit i may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit cok my officials charged with administering county ordinances or other authorized person to have w m o <br /> access to the scribe4 premises atfly <br /> reasonable time for the purpose of inspection. <br /> - m <br /> SIGN HERE ' �^ <br /> (a at a of owner r uilding contractor) date) <br /> : o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP OPERMITS MAY BE REQUIREDo 0 0 N <br /> 8 vi <br /> C9 <br />