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V l / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> o'q <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v In <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m = _ <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. 'o <br /> OWNER �� 1 <br /> c C n O <br /> /f TELEPHONE <br /> las-lu >� - 3ic�.. UaKlx. <br /> ADDRESS <br /> M <br /> EMERGENCY/FIRE NUMBER ROAD NAME ju ' G 1ZV fLA t*) <br /> LEGAL DESCRIPTION (see tax receipt) rO <br /> CONTRACTORA '�r ( / ,- <br /> V 1 � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY _ PRIW o FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> rH � <br /> CT <br /> STRUCTURE/ADDITION USE: S I�Lr�-� 't-, i g o_ <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> o � n <br /> m <br /> 3 0 <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 (W),septic tank (ST), and drainfield (DF). a <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. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be IIgned and 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN B SSUED. 1I a N <br /> PLOT PLAN Z <br /> (( � � <br /> o <br /> p a <br /> � Pl(-0 —,,;fiv 0 41 IOII U� <br /> �`�`t 5 (J0� oPII (rt k6ir,(L l lel �' 0 <br /> `-fo 7 Qi <br /> 'rip- <br /> l <br /> fatv e �o�j0�tilut <br /> rte" 6 � <br /> G1 � IM (1 <br /> rp 10 A)( 0 J l <br /> ODI <br /> LPC a '� <br /> LAKE <br /> BVI IIJERYA <br /> mgOMo <br /> m Y <br /> f <br /> m -$� 1 $ Xl <br /> CONDITIONS OF PERMIT: w:; IF BC g' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ;5 � ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ <br /> e O <br /> ' c_ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl. Xl <br /> o i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informs- In <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize th at this infor- <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 may be a result of the County of Burnett relying on this information I am providir g in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe son to have O'. p <br /> access to the above escrtbed premi at reasonable time for the purpose of inspecti ------- --- ' ` m ' m <br /> SIGN HERE 4AJ0tUAqu <br /> (s n lure of ow or building contractor) { a ) <br /> pi <br /> ZONING ADMINISTRATOR � ) "wry, ' <br /> �� H ' ` ' : <br /> TOWNSHIP PERMITS MAY BE REQUIRED M 9, S 0 ..8 rn <br /> N N {J�N 1T <br /> O N O N m <br /> 88899 9 ai <br />