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Cl i ( COy� / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o a <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m o <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and 2 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. y m <br /> (7/ 0 327- <br /> OWNER TELEPHONF`�e /„h 936— 9&7il a F <br /> o Pe <br /> ADDRESS 733 &J.. ^f'Gt Sr, S I' !, Pt -'S' S-0-33 <br /> j <br /> EMERGENCY/FIRE NUMBER 1 �7 ROAD NAME CO(//v �d 7� Q <br /> LEGAL DESCRIPTION (seetaxret ipt) W t NW I S_ —r-3-79_ 1? (.(.J <br /> CONTRACTOR �C1” <br /> A <br /> S <br /> TYPE OF T S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O _ <br /> M <br /> SANITARY )PRI FILLING/GRADING CAMPING UNIT SUBDIVISION o �� <br /> � � / m r J <br /> STRUCTUREJADDITION USE: `CC , h ° o <br /> v (\ <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o o <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and sizc 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 hefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordina y high water mark of lake,stream, or river. 0 <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 L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'fI 3 rn <br /> 11 Z c <br /> PLOT PLAN 9 a <br /> C t <br /> w <br /> M <br /> CIOI <br /> o <br /> V� N <br /> n <br /> �u O <br /> 1)Vgl, Dny . <br /> 0 I V <br /> O <br /> Q y <br /> N_ <br /> Mai <br /> z <br /> f <br /> 00. <br /> �,� �.a� Qm m <br /> $3:: � Cm g0 <br /> CONDITIONS OF PERMIT: .: 'z 'S ro _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 :i Q "I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. c ^ D <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- ^: C <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- d'm. T <br /> tion contained in this applicat' n(including any accompanying schedule)and I further declare that I 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 <br /> further accept all liability whit may be a result of the County of Burnett relying on this information 1 am providing in this ap- H <br /> plication. I agree t permit co my officials charged with administering county ordinances or other authorized person to have i O N 0i <br /> access to thea a descriD eml"S at any reasonable time for the purpose of inspection. m <br /> m m <br /> i S <br /> C(� J>j�w (O— a-7— <br /> SIGN HERE <br /> (a gnatu�re of owner or building con ctor) (date) o p <br /> ZONING ADMINISTRATOR <br /> e,m Xk T <br /> TOWNSHIP PERMITS MAY BE REOUIRED o25 a m <br /> 000 d $ N <br /> v+ <br /> 0 <br />