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OYL <br /> Burnett County 7410 C4 . Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator mm o 0 <br /> APP ICATION FOR — LAND USE — PERMITS <br /> 0 <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. Th P undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Or inance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wi tonin. ,� m <br /> m m <br /> c <br /> OWNER 1VRG4R /401= R TELEPHONE <br /> ADDRESS iPD, ��TI Q-K i z1.•P <br /> EMERGENCY/FIRE NUMBER �-S)QO 3o4s��, AD NAME :Xi7 y B <br /> LEGAL DESCRIPTION (seat" eceipt) S` <br /> CONTRACTOR se l <br /> TYPE OF PERMIT(S): DWELLI G/BUILDING GARAGE/ACCESSORY STRUCTURE 000l� ADDITION p <br /> n Lt <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> (/' r / <br /> STRUCTURE/ADDITION USE: ` YoLio <br /> (Home/Cabin; <br /> a ommercial Business; Bedroom;Deck;etc.) Z <br /> o <br /> � � J <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 (DIF). o <br /> 3. Show dimensions In feet f thefollowing;(a) buildingto all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordi iary 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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 3 N <br /> PLOT PLANSr /1 i/}/- o y <br /> f�F�— < <br /> m o <br /> CI <br /> mDID Z� <br /> A <br /> r <br /> w If �' N <br /> f <br /> �br J <br /> a Z <br /> ` a <br /> A f <br /> 3 m <br /> g)CD-0 En r- aC 'o <br /> am <br /> CONDITIONS c y.; ,z C 8 <br /> f. DRIVEWAY MUST MEE1 EWAY WIDTH REQUIREMENTS WITHIN 60 D YS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTIN OF TREES AND VEGETATION IS RESTRICTED AL NG SHORELINE. =N: i M <br /> 3. NO GRADING OR SHO IELAND ALTERATIONS ARE ALLOWED UNLESS SPE ICALLY PERMITTED. N b 2 4 m <br /> o : pa O <br /> I declare that this applicatio (including any accompanying schedule)has been exami ed by me and to the best of my knowl- o : : C <br /> edge and belief it is true,cor ect and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- H m m <br /> tion contained in this applic tion(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> malion I am providing will relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0� <br /> further accept all liability wh ch 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 havea a O N v <br /> access to the above descri premises at any reasonable time for the purpose of inspection. : m - m <br /> m 3g <br /> W m <br /> SIGN HERE <br /> Isipiiiatqeof owner ing contractor) (date) <br /> x <br /> C�G 1i i <br /> ZONING ADMINISTRATOR 0 <br /> a x , <br /> x 'x'x <br /> rn es e� � '71 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N ro m <br /> ell <br /> 000 's°� 0 «� y <br /> w <br /> 0 <br />