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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C <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 Wisco isin. N m U <br /> c W <br /> OWNERr Lc���:I TELEPHONE /S. �, �j - l( 4(4 G <br /> 1riei rw ,�� (YI� n� C, <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER -7 S't SROAD NAME <br /> LEGAL DESCR '�r Lt -LN I1 <br /> e) 'J <br /> CONTRACTOR C .-C d- t-vs `/ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Jc o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> STRUCTURE/ADDITION USE: z C 0 <br /> (Home/Cabin;Commercial Business;Bedroom; D ck;etc.) Z o <br /> 0 0 <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 thew II (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions Infest oft efollowing:(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. Q <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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a rn <br /> 11 Z c <br /> PLOT PLAN ��Y b io <br /> slivy �lde�. /Y� A n <br /> - - - V r y m o <br /> C 1 <br /> Fla <br /> Uri + <br /> S�4r.r A4114,'" IN A wP ILOL" DC O&C p <br /> I` ' <br /> �13Y 31 by J Jl4 (EX13} ;xC, Rt ', eme-A Ave. ° <br /> V <br /> 1,,11 hawt <br /> - AAsefit^i'F'locr <br /> - ( X 31 \1 _ Iv perm i Ned, <br /> D� Ky <br /> c3= 9 Rim <br /> -- i£4 - a z <br /> CONDITIONS OF PERMIT: LA kL o m'' 9. <br /> `z C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m <br /> f E N 9 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE i ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> � O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- " a m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- n t ? E $ of V p <br /> mation I am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I (�,1 ; $`a i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am provitling in this ap- d, <br /> plication.I agree to permit cou ity officials charged with administering county ordinances or other authorized person to have N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 9��g� w w N:8o <br /> SIGN HERE N <br /> (ala ure of Moir building contractor) (date) « <br /> ZONING ADMINISTRATOR r889 <br /> TOWNSHIPPERMITS MAY BE REQUIREDN #N m'0 $ $ 8 N <br /> 0 <br />