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(r1 Cv) 7 - <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator A o a <br /> APPLICATION FOR — LAND USE — PERMITS 3'-T - <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and -2 w i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m �� <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 /> / C t <br /> OWNER , I TELEPHONE 0 E <br /> /tJn./-/ Q�� y <br /> ADDRESS �d 1 `� G �'D `✓ _L:� Sf�-f� V'J� `!r <br /> EMERGENCY/FIRE NUMBER �,�� C' ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR L I" r_ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_— ADDITION p <br /> I <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION - 0 <br /> o _ <br /> STRUCTURE/ADDITION USE: l'.0e(` o�y ,� L/o o °– <br /> (Home/Cabin;Commercial Business;Bedroom: Deck;etc.) z <br /> 0 0 <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 drainfieid (D17. <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto 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 9 <br /> dated by the owner. <br /> 00 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a <br /> PLOT PLAN o n <br /> M •� <br /> 0 <br /> m �f 00 -S�7,r 0` ,dtrj <br /> 'J44 <br /> ISN rA-- r ° <br /> IFj W <br /> o <br /> A o✓ �t rv�lry 5� �u d <br /> o <br /> N <br /> z <br /> f <br /> rti c u+ m 0 a <br /> '2. Qw m <br /> CONDITIONS OF PERMIT: <br /> '- mN.: � CS .05 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m �Q : –1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F =r» <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o 62 : <br /> 2 : m <br /> �? <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowt- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «.m w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,`a B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0V o <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 O N o <br /> access to the above described premia at an asonable time for the purpose of inspection. r 3 0 <br /> A 0 <br /> SIGN HEREh2. �f��– <br /> '--(Si a re of o' o ilding contractor) (date) 8 [ <br /> ZONING ADMINIS31UTOR g E E <br /> �. <br /> Fnw�n�wwfr�nw -1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000000In <br /> 00000000N <br />