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Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U . o <br /> APPLICATION FOR — LAND USE — PERMITS <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 County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations Of the Stale Of Wisconsin. <br /> wN m_ <br /> OWNER FAVMOND <br /> 5 TELEPHONE <br /> 1Z, a 0lU I/$� <br /> ADDRESS 1 23 WHEAK� W M 3EA� N SS i0 <br /> 0 <br /> EMERGENCY/FIRE NUMBERc� <br /> ROAD NAME <br /> 1 1? <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDTION O <br /> SANITARY X— PRIVY FILLING/GRADING CAMPING UNIT BDIVISI N o o r� <br /> 0 <br /> a ni � <br /> STRUCTURE/ADDITION USE: �- � }J,�h MQ(_�I � �Ire^ > ��r�L-�! l , -•C��^ o <br /> (Home/Cabin;Com tial Business;Bedroom; Deck;etc.) Z v <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 No h (N). LAJ <br /> J <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). o <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 /> 2 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be at ned and <br /> dated by the owner. 0 0 <br /> 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 11 3 <br /> m <br /> PLOT PLAN 44 o n <br /> � ' <br /> I o <br /> AIfflLRED 0 0 <br /> v� <br /> / <br /> 0 ml s <br /> o <br /> ro ' / <br /> N <br /> i <br /> m <br /> 4 �N <br /> O <br /> Z <br /> � F <br /> R TFC in a <br /> CONDITIONS OF PERMIT: c �N. Z c <br /> 1. DRIVEWAY MUST MEET- DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E 5. ffi Z ? 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` '-1—_rn i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r! �i' Zi In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of ` ' C <br /> y knowl- o , <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of al informa- <br /> 1 <br /> nforma- ; i •+m", T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infer- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. gp <br /> SIGN HERE 3 Z-r <br /> ( (date) ' ' §` <br /> ZONING ADMINISTRATOR I \ ? 285: <br /> TOWNSHIP PERMITS MAY BE OUIRED Ili s:l m <br /> $8 $$ $$ vmi <br />