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V• v -" ( r <br /> Bumett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS '- <br /> m ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describ ad and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement: of the � $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the Is Ns and <br /> regulations of the State of Wisconsin. w m \lSJ <br /> /� c ': <br /> OWNER BD13 IO <br /> IZIP.IES TELEPHONE 17 - g$q - 1(065 n f(� E <br /> m 7 e <br /> ADDRESS zloq W . WA ST- $LOOMIAI rw M14. . ASH31 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ) o <br /> O <br /> SANITARY�_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> 0 <br /> N r <br /> STRUCTURE/ADDITION USE: g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> P�l <br /> ov <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 Nor& (N). <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (DF). <br /> 3. Show dimensions Infest of the following:(a)building to all lot lines,(b)building to center line of road,(c)building IJ <br /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ied and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o y <br /> Z 7 <br /> PLOT PLAN o a <br /> <' <br /> o <br /> C <br /> 1 41 <br /> ftrrh t-44 C-0 <br /> � G <br /> �1 N <br /> `�•'�'yJ - ): T^��<C (,t no��,Yo.,-tcCl !- 7 „e p.fe �� .Sf 41 0-f cA c9( <br /> J <br /> CONDITIONS OF PERMIT: Q CS g's Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> e £ ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M <br /> - <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` rm ' O E ` In <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.1 acknowledge that I am responsible for the detail and accuracy of a II informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue &permit. I $� $ <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 PllnlDn to have ? O; p <br /> access to the above described premises at any reasonable time for the purpose of inspection. e <br /> T <br /> a <br /> fLr1 -3o • 9s « <br /> SIGN HERE191v fti.oio ` '^ <br /> (date) <br /> 's <br /> ZONING ADMINISTRATOR - '• <br /> NNN� T <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N m <br /> 448888 U)) <br />