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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (1 _0 o' o <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and -� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the '^ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable Courtly Ordinances and the laws and 3 n p) <br /> regulations of the State of Wisconsin. m o <br /> � 11 /X� S m <br /> OWNER 1 �C G11 _ 79o - �CJ e/ + n O <br /> 1 G� TELEPHONE <br /> ADDRESS 44 3 �( C Ci,-e.1 e Q 1 r es �.�. SSo�4 - <br /> EMERGENCY/FIRE NUMBER -7 W 1 ROAD NAME Lg500y La, e. C ( ) <br /> LEGAL DESCRIPTION (see tax receipt) 60jefi%w%e„%i IOC a19. 40A .wj 4! IjImEN�� U' <br /> CONTRACTOR 1✓I� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> SANITARr� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bed oom; Deck; etc-) a o <br /> a <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 drainfield (DF). DO <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building -W I; <br /> measurement to the ordinary high water mark of lake,stream, or river. CII(_) ' <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A �\ <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an a m <br /> 7I Z `v <br /> PLOT PLAN i <br /> n o a <br /> LAK ' Ski <br /> 9-3 <br /> 1 1 �j �A� r�bJii l QDI 0 - <br /> In <br /> J <br /> C. <br /> 1 K / N <br /> C' OA <br /> o it <br /> tr Z <br /> U z <br /> t <br /> 13 r � <br /> 1V <br /> g c�uaM.0a� m <br /> f <br /> m $� � amcm <br /> rr% 33 N 9 <br /> O 0 �.; <br /> CONDITIONS OF PERMIT: e m � 'z �C8 <br /> ?O � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ =2 <br /> H <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. c : 62i- p <br /> o : ao <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- J: ai iC <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- t�4.. "i m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 G 8 $ <br /> 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- N <br /> lication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> ess to the above described premises at any reasonable time for the purpose of inspection. m ; 3 o R- <br /> A N <br /> - <br /> p <br /> ERE .8 E <br /> ( gnature f or uil contractor) <br /> DMINISTRATORAUU_ _ <br /> T WNSHIP PERMITS MAY BE REQUIRED 10 0 2 r <br /> opo ��v�$ 0 <br />