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071 a0kPI <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c 0 <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c JJ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. o <br /> w d <br /> a � <br /> c <br /> OWNERZTON Lew +h ey`c. C/iKr(F, TELEPHONE <br /> — _ <br /> ADDRESSr t r�,ole i-ft <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) S A/ f lV I <br /> S ecliv a ��eV�E <br /> CONTRACTOR 37e if <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY <br /> 0 p <br /> _ PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> STRUCTURE/ADDITION USE: 20t <br /> + ,�. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) S ^ <br /> 0 o (�1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) o } G <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Not It (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c building <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 si ned and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE in <br /> 0 UED. 0 a N <br /> PLOT PLAN Z <br /> 1f np o <br /> S � A ucll � L4 I i <br /> w � <br /> \ f M <br /> o 4 n <br /> m <br /> ON <br /> n <br /> _ <br /> m <br /> L <br /> a <br /> N <br /> �J <br /> J <br /> z <br /> f <br /> T. S� 2. m <br /> CONDITIONS OF PERMIT: v m 3. c g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £E' I s <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ i y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' �+� E E g„' C <br /> Lr <br /> 1 declare that this application(including an accompanyingschedule has been examined b me and to the best of 0: <br /> . C <br /> PP ( q Y 1 Y Y forms - o : { i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g'$i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing j n this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized perac n to have10; p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 <br /> m m w <br /> SIGN HERE `� w <br /> (signature of owner or buildi q contrac h (date) <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REOUIRED y r~�~���N" "Sin�1 <br /> ONN $ n. — <br /> � 8888888 v) <br />