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Burnet(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 /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and v °— <br /> located as shown herein. The undersigned agrees that all work shell be done in accordance with the requi <br /> remeltsof the m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. N m <br /> 60 q51 mil <br /> n t� w � <br /> OWNER 1 •/ �� L / TELEPHONE <br /> / 3+ <br /> '7 O o <br /> _ m m <br /> ADDRESS dry <br /> )3 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTIONsee taxreceipt) <br /> ( W/ t 0 ;�Cr-OVI -rbwN YW Raw w <br /> CONTRACTOR r- (` JC �` ✓l ,�._t. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p �� <br /> SANITARY�_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION — a -- <br /> N <br /> STRUCTURE/ADDITION USE: O � <br /> (Home/Cabin;Commercial siness; Bedroom; Deck;etc.) t\ <br /> z o <br /> o 9 <br /> m <br /> Z <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). 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 <br /> dated by the owner. C c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 11 c N <br /> PLOT PLAN ?�'0$T G D 'e7' <br /> O <br /> M <br /> J) <br /> I`-C1 <br /> V d <br /> I)+ o <br /> /V ft Th �3t! ql <br /> 6 � Ee <br /> a <br /> 11 z <br /> �XlG Cubiti/�a+y ey a <br /> D <br /> .t be- eoiuud-t� -6 j <br /> LW4S <br /> m <br /> L�2.a aov <br /> aas g <br /> CONDITIONS OF PERMIT: 3 3.! ,Z C S g't <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 6 IQ —1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. it y y <br /> it <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' rn : G1 '• m <br /> E <br /> 121 <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of ali informs- : to m•+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that than infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ; 0: o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T ' Me <br /> SIGN HERE <br /> not re of owns or building tractor) (da <br /> Ii te) w- <br /> ' .." I A <br /> ZONING ADMINISTRATOR APR 2 4 <br /> TOWNSHIP PERMITS MAY BE REQUIRED I L '' c N N'$ $ <br />