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Burnett County 7410 do. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'Do c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o C <br /> Burnett CountyLand Use Ordinance,Sanitation Code,and with all other 3 <br /> applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m <br /> �^ m <br /> OWNER �( ,� TELEPHONE a. 7 O <br /> ADDRESS v��d.2 /,p 1°J t l .�7rd 9 ..�y^-t �- i ^ ?� �' '''✓ft G7 fl tf I?• ,S�S�C yZ : 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME - <br /> LEGAL DESCRIPTION (see tax receipt) L ,::�''' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING>X GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> d6,� ffc�r� o o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z <br /> ° 0 o OZJ <br /> m <br /> a <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). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 <br /> 71 z c� <br /> PLOT PLAN ° n <br /> I� y <br /> l•' <br /> p 11' <br /> I <br /> A" Wal (C <br /> - - - <br /> - p N <br /> , s M <br /> ! 1 (j <br /> 1 ri ((1_ <br /> f <br /> /�_ ito 6e 63 <br /> 1.0W���T'N �fY°.,rt:�- ►'�b:(e d��(/+� c5 v¢sr�.,, a D➢ 'p <br /> CONDITIONS OF PERMIT: g R. Z �c ao 7+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f c 1 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _S2 i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. f"n O <br /> g <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- .es : y!m�.; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 u 8 <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' a <br /> tet : 3 $ r <br /> m A • 2 <br /> SIGN HERE .,,,. < v // 8 ' <br /> (sign t er or ng contractort (date) �{ <br /> : <br /> ZONING ADMINISTRATOR i <br /> TOWNSHIP PERMITS MAY BE REOUIRED OCT 1 61992 3!x P SAP 8 s , " <br /> $ 888888 fn <br />