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an (6YAP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admin strator m 'a 1 Z <br /> t 1 E o <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> TO THE ZQNING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and tt <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremel itsof the a <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the aws and <br /> regulations of the State of Wisconsin. v m <br /> �1 c '? <br /> OWNER SNI vt yJ 4UQ TELEPHONE fZ,_ z _S 41 n E <br /> O o <br /> ADDRESSoA) 0 0-f4- <br /> u <br /> EMERGENCY/FIRE NUMBER2-3 ROAD NAME <br /> OON <br /> LEGAL DESCRIPTIONsee tax receipt) � <br /> c P) �4 Cpm�i <br /> , G <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING /�` GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O0 <br /> S <br /> �� J I l� � S � y <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Ca in;Commercial Busin s ,Bedroom; Deck;etc.) <br /> = o <br /> 0 v <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 1 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate Nort i (N). <br /> 2. Show the location of the well (yi),septic tank (ST), and drainfield (DF). 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 <br /> measurement to the ordinary high water mark of lake,stream,or river. S <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SUED. 7I 3 to <br /> c <br /> PLOT PLAN o $ <br /> C o <br /> rN <br /> O <br /> O <br /> x <br /> 0 <br /> O <br /> �\ <br /> � I 2 H <br /> 4 r ti C7 _ <br /> - <br /> S M <br /> ( m <br /> CONDITIONS OF P RMIT: °i-iaU Q-"A <br /> 1. DRIVEWAY MU T MEET EMENTS WITHIN DAYS OF PERMIT ISSUANCE. e £ �� <br /> 2. REMOVAL OR-CUTTING OF RESTRICTE ALONG SHORELINE. _ =N M <br /> 3. NO GRADING OR SHOR ND ALTE TONS A E ALLO UNLESS SPECIFICALLY PERMITTED. . . . . O m <br /> € 8e € o <br /> 1 declare that this application(i Ing schedule has been examined by me and to the best of y knowl- C <br /> edge and belief it is true,correct and complete.I acknow ge roar I a responsible for the detail and accuracy of al I informs- ': a+m« rh <br /> tion contained in this application(including any aecompan g sched le)and I further declare that I recognize that his infor- �' B <br /> matlon I am providing will be relied upon by the County of urnett Wisconsin in determining whether to issue permit. 1 rh8 <br /> further accept all liability which may be a result of the Count of Burn relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with admi istering c ty ordinances or other authorized person to have - p i <br /> access to the above describeq premises at any reasonable ti for the purpose of inspection. ref <br /> ♦ m m a <br /> SIGN HERE <br /> (signature of o4mer 115rjii o _(dale) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER M € I I 8 N N N N g m <br /> �`,( E 88888888 H <br />