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eZ'7 � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. N m <br /> c <br /> n O <br /> OWNER Rorence M , �hn 'n TE�LEPHON�E, lQ ��-•� <br /> ADDRESS �O l••�__Glb L� buo1 V4-Z /TU,5D e l <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR raa 4P — \ j cu-P(An r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING d RAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °- <br /> J <br /> m r <br /> o 1 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck,etc.) o o O <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 drainfield (DF). <br /> 3. Show dimensions infest of the following:(a)buildingto 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. 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 ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 to <br /> 71 Z `c <br /> PLOT PLAN ° a <br /> M o <br /> C ' <br /> pr ) 4-3-- ) 44 <br /> n_ <br /> o` <br /> N I� <br /> O <br /> J <br /> J <br /> O Iy <br /> 2 <br /> I � <br /> i; <br /> 9 Rm m <br /> w K G a a M <br /> CONDITIONS OF PERMIT: o m y;: Q c 8 T� <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c %Q ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^ rn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o mO <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 2i - C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- " : y n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B 8 i p <br /> mation 1 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 a e 0 <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N 0 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 w <br /> m mA <br /> N N 0 <br /> SIGN HERE « <br /> (signature <br /> �off owner or building contractor) (date) <br /> o <br /> ZONING ADMINISTRATOR V/ « $ r <br /> « «,�«r« .A«, m <br /> TOWNSHIP PER ITS MAY BE REQUIRED o o^i o^i of "P 8 N <br /> $ oogo8o $ N <br />