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6n cz3fW. <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 — PERMITS3 <br /> d 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 3 <br /> regulations of the State of Wisconsin. v >90 <br /> w m <br /> c m ^ <br /> c w <br /> OWNER G�yn 02_547.A/ TELEPHONE n f <br /> o <br /> ADDRESS �7 33S Ls4sT LDh/�D/LS ��St�Lf/Lp wG�3'3�y2w� 5'4?P53 <br /> EMERGENCY/FIRE NUMBER , 5, ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 01 <br /> CONTRACTOR 5e:, Al <br /> TYPE OF PERMIT(S): DWELLING/BUILDING. GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: njS(,� � o g <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) J Z <br /> 0 0 <br /> a <br /> 3 <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 (V), septic tank (ST), and drainfield (DF). 0 <br /> 3. Show dimensions infeet ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building -q <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 2 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 oon <br /> N <br /> PLOT PLAN z <br /> �—eZ� M a rnZ <br /> Corr/-ro✓s � <br /> 9J <br /> 0 V <br /> SlfZ' f}�14Gl�G�� f'G X I D tLw (p <br /> o � <br /> N <br /> V <br /> Z <br /> S <br /> O c m <br /> D' u' <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> o F T'Z 1 <br /> 2 REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 8 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o A inD m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa w m(» : O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 3 N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i $ m $ <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 Ur, N o <br /> access to the above described premises at an onable time for the purpose of inspection. <br /> J N <br /> SIGN HEREMa <br /> N <br /> (signature of n or in for D ( e ' <br /> ZONING ADMINISTRATOR ((qq <br /> TO NSHIP PERMITS MAY BE REQUIRED 5 ( H N N N H <br /> N N N O O <br /> 8 O O $ $ <br />