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-- 600vyo <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adftiinittrator rn 'a -1 z <br /> fo <br /> (` APPLICATION FOR — LAND USE — PERMITS m _ <br /> TO,THE ZONING ADMINISTRATOR:The undersigned here makes Q <br /> 9 by application for a Permit for the work descri and w <br /> looaikt-wghown herein. The undersigned agrees that all work hall be done in accordance with the req sof the m = <br /> Burnett County Land Use Ordinance,Sanitation Code, other applicable County Ordinances and the I ws and <br /> regulations of the State of sin. - o <br /> OWNER //// l ,,�/�/ <br /> �LG L,�� G'®/f /v HONE <br /> O = <br /> ADDRESS / 0"1 y1 dT r <br /> /' I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) v T <br /> CONTRACTOR �`-/ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING�/GiRADING CAMPINGUNIT SUBDIVISION o <br /> 0 <br /> a r <br /> STRUCTURE/ADDITION USE: . a 741,00 0 <br /> (Home/Cabin;CorAmercial Business; Bedroom; Deck;etc.) � <br /> Z o <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ll l <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). O I <br /> 2. Show the location of the well (Vi),septic tank (ST),and drainfield (DF). _ ? <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)t uilding J <br /> measurement to the ordinary high water mark of lake,stream,or river. O <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sigr ied and <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o y <br /> PLOT PLAN M Z `c <br /> o a <br /> m <br /> 1 <br /> © O <br /> _o <br /> \1 O IN <br /> J <br /> IVA <br /> O y <br /> v a <br /> v✓ ��Tf6 Q � � <br /> 'CLQ - <br /> CONDITIONS OF PERMIT: a.i C g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. OZ 0 5': <br /> _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rr,,,, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V.F i G m <br /> 0 <br /> 1 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 informs- «ro« m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that t is infor- i i <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g13 $ <br /> further accept all liability which may be a result of the County of Bumett 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 <br /> access to the above described premises 4,t any reasonable time for the purpose of inspection. <br /> SIGN HERE _ 7 <br /> (situ of owner orbuI"ng contractor) - (date) « <br /> ZONING A INISTRATOR l"'� l��y 8 <br /> $ i <br /> TOWNSHIP PERMITS MAY BE REQUIRED "1 I 813 <br /> 00 $N"N m« <br /> lu sssss $ N <br />