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( (Burnett County 7410 Co. d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 `v O-+ �Z <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and in <br /> located as shown herein. The u dersigned agrees that all work shall be done in accordance with the requirements of the m P <br /> Burnett County Land Use Ordin ince, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisc nsm. - o <br /> bra 6aS- y96y- c. � w <br /> OWNER - crL, <br /> TELEPHONE _ '9-5 9 35 p n o <br /> ADDRESS m ^'� <br /> o /9v <br /> EMERGENCY/FIRE NUMBER3 ' I C ROAD NAME 'e Lt C [J <br /> - J1 oc <br /> LEGAL DESCRIPTION (see tax rec ipt) C _ - a <br /> A4j1 U tJ a b1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/E UILDING GARAGE/ACCESSORY STRUCTUREADDITION 11 ' <br /> 0 <br /> SANITARY PRIWFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: e, <br /> o ° <br /> Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> p <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size f all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the we I (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions infest oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordina high water mark of lake,stream, or river. 0 <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. <br /> NOTE: BUILDING/STRUCTURE LOCAnONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. G o <br /> PLOT PLAN ) 71 Z Q <br /> 7 / <br /> m o <br /> 0` MIf <br /> L <br /> C A b8i a, <br /> WGIfT <br /> r i <br /> n Septic DPA In o <br /> f=i e117 <br /> o J <br /> r � T <br /> r � <br /> v Z <br /> � rgci �t/d <br /> -o Ac0,e-5 <br /> oga � s m m <br /> CONDITIONS OF PERMIT: a D-� . w . 9 <br /> = N' z �ffiga' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o �•Z � : � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° f � <br /> 3. NO GRADING OR SHORELA D ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. tl' 25 2 P i m <br /> � . ta: <br /> ' o [ B E° E D <br /> I declare that this application(incit ding any accompanying schedule)has been examined by me and to the best of my knowlc m C <br /> edge and belief it is true,correct ar d complete.I acknowledge that I am responsible for the detail and accuracy of all informs- Fw y <br /> tion contained in this application(i cluding any accompanying schedule)and I further declare that I recognize that this infor- m b" is m <br /> mation 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 me y be a result of the County of Burnett relying on this information I am providing in this ap- g x <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 pr nises at any re ble time for the purpose of inspection. i o0i 0 m <br /> � X <br /> SIGN HE <br /> s , 5LS -9y <br /> (signs re o er o uilding contractoq '^ <br /> �^ (date) G io <br /> ZONING ADMINISTRATOR o - <br /> I� r-� i" � ' <br /> X [ <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N N x m <br /> 008 'otmA <br /> N <br /> H <br /> O <br />