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P- cm-p l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54672 Office of Zoning Administrator rn '0 c o <br /> APPLICATION FOR — LAND USE — PERMITS >< <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremf ints of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> w � <br /> OWNER. C� �yf / ,) TELEPHONE {�^ `� <br /> ADDRESS L /� - Gt1 Zy` ' s J C ✓1/ w �AA w <br /> EMERGENCY/FIRE NUMBER ROAD NAME t (1 <br /> LEGAL DESCRIPTION (see taz receipt) PLL A/141 z - 5-o21 ;"fCA <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o U <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> w s <br /> STRUCTURE/ADDITION USE: a4ftg6 c7 ° <br /> (Home/Cabin; ommercial Busines ; Bedroom;Deck;etc.) Z o <br /> 0 v Q <br /> a T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ` T <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate No rth (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DIF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,( )building <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 O <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be a Igned and 2 y <br /> dated by the owner. c 0 l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> 11 Z Q <br /> PLOT PLAN m a <br /> 1 �J I� <br /> c C 3 7 /l � � <br /> I� <br /> P <br /> 3 <br /> I� 3 z -r <br /> 30t <br /> j <br /> O 4 <br /> I o � <br /> � w <br /> n <br /> f <br /> g �� In <br /> 33 <br /> CONDITIONS OF PERMIT: o < Z. Q CS g 2 r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F IQ: ' =I2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. coN` 1 <br /> W€ N i gM <br /> . m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 25 � <br /> E ' E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy f all informs- � m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- vl? $ B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; $`Q 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providi ig In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ; m c <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 <br /> m w <br /> SIGN HERE <br /> Is re of ow or or building contractor) o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED It' <br /> °8888 88 u <br />