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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H C <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a c Uj <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. m <br /> All <br /> C <br /> OWNER TELEPHONE f <br /> A N fA/?IJ€R CAFE a <br /> v ' <br /> ADDRESS ZAC)q M Rn• A -N � rkAWS m m <br /> EMERGENCY//FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TY PERMT7S1; DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE_ ADDITION _o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> J <br /> r <br /> STRUCTURE/ADDITION USE: o <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> o ) <br /> m <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). �t f <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 4 ,�- <br /> 3. Show dimensions In feet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary 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 Z <br /> dated by the owner. 0 o ITI <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I a rn �tl <br /> 7I z cv C <br /> PLOT PLAN n o a <br /> m o <br /> �%T'AccHl,+� m <br /> I <br /> U/ <br /> ZZ <br /> N <br /> o <br /> ' <br /> N <br /> O <br /> J <br /> m <br /> 0 y <br /> N <br /> Z <br /> 1 <br /> C <br /> l <br /> mc� + ro a� 9 <br /> m -$.� ? nmamm <br /> CONDITIONS OF PERMIT: ^ - Q $ ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e F-0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG/SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'mo _ 61p <br /> �6 : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o C <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<: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i1 a o : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I gnioi <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 E ON <br /> 0j <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m m O N <br /> � rm MRM a o <br /> SIGN HERE 1-�'c-r- w 0 <br /> (signalture of o r ding c t ctor) ULdi* <br /> ZONING ADMINISTRATOR bs� Ile <br /> g <br /> OITIlienINus <br /> • - <br /> TOWNSHIP PERMITS MAY BE REOUI ----J;i�I o 0 o b o 0 0 o m <br /> 00000000 f/1 <br />