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Cin crnp , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> m <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 $ <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m o <br /> w m_ <br /> c m Q <br /> O O <br /> OWNERSTC <br /> �,[ nn /� nn / TELEPHONE <br /> iJ� p- lGu/f7 /7N�e ' 'e NP / <br /> ADDRESS �38a ` tel yt C n 0, 2 O m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) a. T 38,'11 ,1 /d[j LJoU,/riJ e- 0 ( �. <br /> W <br /> C <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ^O o <br /> SANITARY PRIW 9RA9i{N CAMPING UNIT SUBDIVISION o <br /> y- f^ Olin o r <br /> STRUCTURE/ADDITION US <br /> v <br /> Home C ess;Bedroom; eck;etc.) Pe�nljt o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) r r <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 (W),septic tank (ST),and drain!told (DF). d <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 0 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. C) <br /> NOTE: BUILOING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o ut <br /> 1A Z o <br /> PLOT PLAN <br /> M o <br /> M 1 , <br /> fA <br /> �J <br /> to <br /> � � <br /> O / <br /> I� <br /> J IR <br /> O ti <br /> Z <br /> S <br /> l I� <br /> "y <br /> 94 332. M <br /> CONDITIONS OF PERMIT: g E. g i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ _� ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> Tri- y` ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` S t gg m0 <br /> X ; <br /> Q <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know]- i O i M M m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- S $ <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this Infor- O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 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 person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m <br /> M a <br /> SIGN HERE <br /> (signature of w or dieto (date) <br /> ZONING ADMINISTRATOR <br /> NweaNwi+,�a±' <br /> TO NSHIP PERMITS MAY BE REQUIRED o IN ` <br /> 888888 <br />