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Bumett,tounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS d o J <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 ,� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of 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 d <br /> w � <br /> c <br /> O <br /> OWNER TELEPHONE <br /> Foci OWNER L �ff�So <br /> ADDRESS &-3-ao 14111yle_S z%z� <br /> EMERGENCY/FIRE NUMBER 2D ) 2 ROAD NAME s'o S/tp/�oL �L/ C <br /> —� I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR C74faT- ,C..O/eS �ki l61C/LS / c, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 'L o <br /> _ n o <br /> SANITARY PRIVY ''// FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: f-014 C /�sf6/� � 2�kc o -' <br /> (Home/ abin;Commercial Business; Bedroom; Deck;etc.) o o <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) � J <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 (D17. <br /> 3. Show dimensions infeet of thefollowing:(a)building to all lot lines,(b)buildingto center lineof road,(c)building -0 <br /> measurement to the ordinary high water mark of lake,stream, or river. -P-- <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and (� 'i <br /> dated by the owner. C e lY <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o N <br /> 11 Z Q <br /> PLOT PLAN ° <br /> m o <br /> C <br /> a � <br /> w <br /> A?c-h,,L )01 Plan <br /> N ,T• p.[�+ <br /> O V � 1 <br /> J <br /> \ J <br /> N_ <br /> n <br /> 2 <br /> i {IIw—Ir <br /> 1 <br /> I <br /> m O c d r O M <br /> m <br /> m3:2. _ y <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> itk <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. N G7 i m <br /> a : t In <br /> I 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 all informa- H a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 ? p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I t": E $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i O N o <br /> access to the above descr premises at any reasonable time for the purpose of inspection. r 3 $ ; <br /> m A N <br /> 28 ae� y3 € <br /> SIGN HERE <br /> (sfgnatur f owner or building contractor) (date) t <br /> ZONING ADMINISTRATOR <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N UW N ^d a <br /> $ $ $ $ $ 8 $ $ tm/+ <br />