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i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w v -t z <br /> APPLICATION FOR — LAND USE — PERMITS 9 _ <br /> f ° <br /> TO THE ZONINdADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and z <br /> located a3 shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 Cc <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. w o o <br /> OWNER I / C n <br /> CRQf {CS w ' T`ro(AMC4, � TELEPHONE `IISS�v ' Ta O <br /> / cI p �� <br /> ADDRESS 9 y o C _C_ <br /> 2 d a yy l.u� SZ{Q <br /> EMERGENCY/FIRE NUMBER a S q O ROAD NAME C C C 2 1 <br /> LEGAL DESCRIPTION (see tax receipt) se <br /> CONTRACTOR c e I F <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ p <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o � <br /> _ <br /> STRUCTURE/ADDITION USE: lice 4 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z v <br /> 0 0 <br /> v <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). 0 <br /> 3. Show dimensions in feet of the following:(a) building to all[at 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 signed and <br /> dated by the owner. o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o y <br /> PLOT PLAN z <br /> Q <br /> o a <br /> S P� , C In N: <br /> c CLot Ll in <br /> 1 <br /> Q ;- <br /> r i e <br /> n <br /> 30 �1� <br /> _ <br /> f � 1 <br /> T� o <br /> cz <br /> v <br /> v <br /> LA) Z <br /> to o > > � m <br /> LD EL <br /> CONDITIONS OF PERMIT <br /> 50� Ho � = � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 0 o z D <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. I n O <br /> $ i u n c i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m.m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- fn v. a <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8,o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <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 O u, <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 $ R <br /> [TJ N A H <br /> SIGN HERE N d <br /> (signal o owner or buildi g contractor) (date) <br /> o x <br /> ZONING ADMINISTRATOR "�� $ E <br /> TOWNSHIP PERMITS MAY BE REQUIRED Yv ro — ro m 8 `o <br /> u vt <nofno .`�i' m <br /> $ 8 $ $ 88 $ 8ai <br />