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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (a 1 ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS - 0 <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 11 $ <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 Wisconsin. w m <br /> (� {� o <br /> OWNER obeR4 Remo 2, 1+ ime-k TELEPHONE <br /> R /f�_ ys•S_ 38a�( �_ >: <br /> t` rJ <br /> n� n m m <br /> ADDRESS 331- (e•�t ,- A-ye. A/o &.S�•PLL IVA S.SO-2 <br /> EMERGENCY/FIRE NUMBER ROAD NAME DoeK Lemke pd>41 ) <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) V6L ®*wQ #5 <br /> CONTRACTOR l <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONa ° <br /> STRUCTURE/ADDITION USE:541491. l/✓Y- 'T-It�'�I/�'R <br /> (Hom Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 o — <br /> o f ` <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 (yi),septic tank (ST),and drainfield (DF). I r- <br /> 3. <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building 1q <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 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1! 3 m <br /> 11 Z o <br /> PP LAN p o <br /> 0 <br /> �Zk 1 C <br /> a 4�1 s <br /> -o <br /> sot r <br /> o <br /> t— + <br /> ;o e r Z <br /> A (a <br /> N <br /> CONDITIONS OF PERMIT: g Q c g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 00 DAYS OF PERMIT ISSUANCE. - <br /> a £ Z In <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N i In <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rr' i `• Q .` <br /> S <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 Informs- N m}+? m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I f $ $ <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 <br /> access to theabove scribed promises an reasonable time for the purpose of inspection. T pG <br /> x <br /> M . <br /> SIGN HERE ' M E <br /> (slat of owns Ilding contractoQ ' I r <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED 1 9 1 "t <br /> oLa; iSiSUNi"0'S5m <br /> 11 88888818gmi <br />