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BurnCt County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 -a f <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO TFiE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descris <br /> d and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremeof the m <br /> Burnett County Land Use Ordinance,Sanitation Cafe, and with all other applicable County Ordinances and the and n <br /> regulations of the State of Wisconsin. m m -� <br /> m <br /> OWNER 14gy �nuC,S WEE <br /> TELEPHONEr�IIS -3�4 Cl _SS98 <br /> ADDRESS 9111 $f..,ACKBKDaK 1�� • WEB5SR f int i • 54S93 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> cl1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> ci �I <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> J <br /> '^ r <br /> STRUCTURE/ADDITION USE: ° o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z p <br /> 0 0 <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 Norl h (N). n r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF]. 4 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c 1 building <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. C) 8 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. v <br /> 71 Z o <br /> PLOT PLAN A o o �^ <br /> to y } <br /> O IV. <br /> C I J <br /> TfAL�I I� M r <br /> y <br /> I � <br /> G' <br /> �✓ N <br /> O <br /> O <br /> IN <br /> J <br /> 0 I� <br /> J <br /> O � <br /> Z <br /> my�tnr DD£ V <br /> e m �m m <br /> CONDITIONS OF PERMIT: I v g 2; C8 g's Z <br /> o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. - <br /> F (n M <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. ` rQ"'• O L i i p <br /> 5 <br /> 2 : E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 05 <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy o l all informs- M m'" m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th t this infor- $B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ? 0 $ E <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providir g in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe on to have ? 0: p <br /> access to the above described promises at any reasonable time for the purpose of Inspection. E 3 ? !4F <br /> T m a <br /> SIGN HERE <br /> (date) <br /> (sign uro of owner bull ng. t <br /> ZONING ADMINISTRATOR 8 <br /> Mw wwH� T <br /> TOWNSNI PERMITS MAY BE REQUIRED N N SS m <br /> 8$ 8888 of <br />