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an comp . <br /> Bunntt county 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator m a o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m ° <br /> TO THE ZUNING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located ere shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burner Courtly Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and l <br /> regulations of the Slate of Wisconsin. w m <br /> c <br /> OWNER TELLEPHONE m <br /> ADDRESS <br /> D /CNK _S7� A/_ <br /> /nZ__S14JN• SS11/�� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> i <br /> CONTRACTOR <br /> —� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVYFILLING/GRADING CA ING UNIT SUBDIVISION p ° <br /> J <br /> P r <br /> STRUCTURE/ADDITION USE: /APY <br /> (Home/Cabin;fommer&al Busi ;Bedroom;Deck;etc.) o g <br /> m <br /> 3 <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 drainf laid (DF). K ° <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building t <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a y <br /> c <br /> 2 v <br /> PLOT PLAN n o n <br /> 0 <br /> C <br /> m Z <br /> �i�C�/tyn w Ir 1 <br /> l <br /> I ` io <br /> ° <br /> 0 <br /> 0 <br /> 0 <br /> O <br /> m W <br /> O - <br /> Z <br /> D WW MW;- DDO o <br /> o c . 0 J o a F m <br /> Z. 9 <br /> 2 : PC ' ' ; <br /> CONDITIONS OF PERMIT: <. 'P': `Z P O J o'pJ <br /> S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z `0 : 1 <br /> 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J - 31 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �i, O <br /> 'P c : <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of my knowl. g i o'm ; C <br /> PP ( g Y 1 Y o : O ? 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all infonna- �a : ` <br /> 4 m <br /> lion contained in this application(including any accompanying schedule)and I further declare that 1 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 ? g u 8 <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.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. ( 88 , <br /> mm ? o A <br /> n <br /> SIGN HERE ~ MP <br /> N P <br /> (signs of owner ouI dinp contractor) (date) f 8 ; .o <br /> .✓r, ..Ct : : g i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED kv'�v' U�' c c m <br /> a <br /> 88888i <br />