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err �mQ, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N 'ao 0 <br /> APPLICATION FOR — LAND USE — PERMITS st <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work tlescr`bed and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementsof the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the aws and _ <br /> regulations of the State of Wisconsin. a m <br /> OWNER �,Sc✓ G' C<� r ke,'% TELEPHONE 1 L., tet' Z G'( 3 E-s g ' O <br /> }- pr M A <br /> ADDRESS Lit 77 I `IzVQ S* LJ, aetlQ IIG.It'j n4N Ssl17 jtj <br /> ) <br /> EMERGENCY/FIRE NUMBER ROAD NAME N <br /> LEGAL DESCRIPTION (see tax receipt) N L A Sec-20 u ✓t ILIJ ,.., <br /> CONTRACTOR �' ✓� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ,/GARAG CCESSORY STRUCTURE ADDITION _ p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> QKASTRUCTURE/ADDITION USE: I o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o <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 dralnfield (DF). I 0 <br /> 3. Show dimensions in feet of the following:(a) building toall lot lines,(b)building tocenter line ofroad,(cllbuilding 1f <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 sigIII <br /> ned and 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BEtSUED. 1I o N <br /> PLOT PLAN o n <br /> f � o <br /> Nw(� ss L ice C <br /> III aw <br /> m <br /> Al <br /> 1 III � m <br /> 0 <br /> �o e <br /> N <br /> O y <br /> 40 <br /> ---------------------------------------- <br /> 4c 3`0 <br /> R b'inOFs>f M <br /> e <br /> R2.2.a§ m m <br /> CONDITIONS OF PERMITc <br /> : 8 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Te SQ I 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o =—'=Q: W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ : Q� : m <br /> of <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 3 : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- N m N <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- l 8 1 m <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 3 permit. I <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 Pers n to have O@@ 0 <br /> access to the ve described premises at any reasonable time for the purpose of inspection. @@99 <br /> m <br /> _ m m <br /> SIGN HERE 14 <br /> If (signature of owner or building contractor) (date) <br /> � i <br /> ZONING ADMINISTRATOR S <br /> NN4'NNN+N T <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 N N f; N N i5 m <br /> 88888888 rmii <br /> �I� <br />