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60 C64 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <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 v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 c I <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 Wisconsi . N m <br /> A <br /> OWNER ) TELEPHONE (!! � o o <br /> / I m_ <br /> ADDRESS ) LP S W, L—r �R r f U E � nc Ir <br /> EMERGENCY/FIRE NUMBER - ROAD NAME Pery-V L,4re- <br /> LEGAL DESCRIPTION (see tax receipt) U4 06 m <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> 0 ? <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: <br /> 0 0 <br /> v <br /> (Hone/Cabin;Com (ejtial Business;Bedroom;Deck;etc.) z o <br /> o v <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of 311 existing buildings (EB) and all new buildings (NB) and Indicate North (N). � <br /> 2. Show the location of the well ,septic tank (ST),and drainfield (DF). ° <br /> 3. Show dimensions infeet of the ollowing:(a)buildingto all lot lines,(b)building to centerline of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. Q (� <br /> 4. If separate plans are submittedby an architect,engineer,builder,contractor,etc.,the plans must be signed and 9—) <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o m <br /> 71 z `c <br /> PLOT PLAN P <br /> m o <br /> C 111 <br /> M <br /> I <br /> G <br /> b = <br /> 1 30 — <br /> � `r N <br /> .l o <br /> m <br /> N <br /> » I� <br /> J o <br /> z <br /> �h I_ <br /> 5--fake <br /> N-la-Qy ak- <br /> j - <br /> CONDITIONS OF PERMIT: <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 F `; �'z � M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =N At <br /> h <br /> 3. NO GRADING OR SHORELA D ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : 'No : L7 : G <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 : J;) <br /> . m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application i including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be reli d 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 tohave <br /> access to the above described promises at any reasonable time for the purpose of inspection. T , 3 8 <br /> m <br /> No <br /> SIGN HEREC <br /> XASig', t re of ow r` ng contractor) <br /> x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED APR ' T ? 'o n N �mN <br /> obo g <br /> 000 <br /> 1------."�---- <br /> hbCE/iT '� Sc� <br />