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� 1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54x72 Office of Zoning Administrator Vim" : o c <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett Courcy Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. �, m <br /> u ip <br /> OWNER TELEPHONE ,// p NiLC ��I1an 'yfip - � GJ �-/ o �4 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER a3 9� ROAD NAME /`;Ya.�lr�. /✓�.J' �� <br /> LEGAL DESCRIPTION (see tax receipt) F C� } DGop_ I'l 7/) U <br /> CONTRACTOR - d -- -- - - <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_� ADDITION p <br /> n G1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> a y ' ' <br /> STRUCTURE/ADDITION USE: G(} r 6L °— <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <br /> m <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 dralnfield (Df). <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. <br /> 4. H 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. 'w o y <br /> Z `c <br /> PLOT PLAN /V—� * <br /> � o a <br /> Ila % C <br /> I <br /> p 361 <br /> WeLL <br /> S / <br /> '1 <br /> Y, <br /> QQ11 i <br /> I � <br /> 'V I <br /> E� Q. <br /> g� e a o <br /> CONDITIONS OF PERMIT: = 3 ' .Z C g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c 1.i E I Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ell 1 9 <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 knowl. ' t - C <br /> a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i �+ �+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 $ <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 promises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (signal of nor or bull r r1:3ng contractor) � dd"*P f'39 <br /> ZONING ADMINISTRATOR I 'Ii i g i N <br /> TOWNSHIP PERMITS MAY BE REQUIRE JUL 2 9 1994 j �'I o >s, IV,� m <br /> �I 8888 88 H <br />