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Burnett County 7410 CD. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. _ <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. Tt is undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Of Jinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of W sconsin, w d <br /> -?3C8 m Q <br /> OWNER �AY, �„CG TELEPHONE 0 £ <br /> ADDRESS / N ' AE 19 <br /> /V yr^r—, V m <br /> C f <br /> EMERGENCY/FIRE NUMBER Q� �-.-7 ROAD NAMEPO✓N— <br /> tu� /I l I <br /> LEGAL DESCRIPTION (see tax receipt) 't d CSm 0"I too� I I a <br /> CONTRACTOR 'Se OF 23 <br /> TYPE OF PERMIT(S): DWELL G/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Ca m;Commercial Business, Bedroom; Deck,etc.) Z o <br /> ° O V <br /> 2 I <br /> 3 <br /> DIRECTIONS FOR PLOT F LAN 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 fir a well (W), septic tank (ST), and drainfield (DIF). <br /> 3. Show dimensions In fee:of the following:(a) building to all lot lines,(b)building to center line of road,(c)building - <br /> measurement to the orc inary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are su 3mitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and p <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11I v w <br /> PLOT PLAN p^ 191-137 <br /> Fnr SHN`t^�, to ( <br /> 1 <br /> noI tt�� <br /> 04e 0 <br /> Q o U <br /> ° <br /> � n <br /> ` o <br /> 1 � <br /> me J <br /> �U J <br /> x.301 �I f <br /> 2 �m0 of r <br /> ^ 4 m . <br /> fir C m g. <br /> CONDITIONS OF PERMI : " I < m Q ti 8 rc _ <br /> 1. DRIVEWAY MUST ME1.7 DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCI�. Z ° <br /> a Ems : 2 <br /> 2. REMOVAL OR CUTTIt G OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I I E <br /> 3. NO GRADING OR SH RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '^ o <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- g y i <br /> tion contained in this appli at ion(including any accompanying schedule)and I further declare that I recognize that this infor- jjB t <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 m hich 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 m N m <br /> access to the above descr bed premises at any reasonable time for the purpose of inspection. <br /> 1✓ /"JIc�L `� ' L N N <br /> SIGN HER � � 'J$ ;"i <br /> (si at a of owner b ding contractor) (date) ro: <br /> € xii <br /> ZONING ADMINISTRATO ` g x <br /> x �r p <br /> �N Nr�0 N1(� Itl id <br /> TOWNSHIP PERMITS MAY BE REQUIRED O u1 N m1� N D d O�5f <br /> 0 <br />