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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 0 0' o <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a p <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and9-1 <br /> regulations of the State of Wisconsin. , <br /> OWNER f1OBE1� ZIEMl=2 TELEPHONE g6G_ 1, C, 3 $ e E <br /> D O <br /> m_ m <br /> ADDRESS 'p O 13ox 4SO V1650151Z \,J I ->`42gS e <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 1 <br /> -� N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <_ <br /> ° — <br /> a r <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> O C <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 drainfleld (DF). 0 o <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building d <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o <br /> Nm <br /> �_ Z v <br /> PLOT PLAN ° n <br /> <. <br /> N <br /> �1 CR c-�Aeo f: t 0� <br /> l^ <br /> co <br /> I 3I <br /> C), <br /> n <br /> CJ <br /> 31 <br /> N IIIII�yf/� <br /> Z <br /> I t <br /> G <br /> CONDITIONS OF PERMIT: z' Q ffi S g'3 IC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E ' i M,2 ` ' <br /> y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' — ' : M <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 know) QS5 <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all Informs- <br /> . : m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue •permit. I <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 parson to have <br /> access to the above described premise*at any reasonable time for the purpose of Inspection. <br /> f 1I o q q, <br /> SIGN HERE <br /> �iV�Atu�� <br /> (signatu of owner of bueding contractor) (data) ; <br /> m <br /> C" AUG 'L 21994 " 8 <br /> ZONING ADMINISTRATOR ` �g ? '• <br /> TOWNSHIP PERMITS MAY BE REOUIRED ' -- _- 8 8 8 8 N«fS T <br /> LN <br /> 1818 fmir <br />