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4WYL, <br /> Bumett Codnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS m 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc it' and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requi=em s of the $ r <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m <br /> m � / <br /> OWNER en,�� ® TELEPHONE �����00 n E <br /> ADDRESS <br /> \I <br /> EMERGENCY/FIRE NUMBER Z�1 J '7) ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Z07� E Lo"'1/ S;'17 X CVV (� <br /> \ l <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p �' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ti o <br /> (3 ° <br /> , Ul7 <br /> STRUCTURE/ADDITION USE: ,(jPdrooM a ° <br /> (Home/Cabin; ommercial Business;Bedroom;Deck;etc.) Z o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) o ? <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,( )building <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s igned and <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 o y <br /> PLOT PLAN ° <br /> s <br /> 10r <br /> ,oA;�►� ��In � a <br /> x, <br /> 3S� s <br /> N ~ <br /> DoT l� <br /> Z <br /> I <br /> /00 V1 <br /> / L � <br /> f/1 rA�rnr8 :E M <br /> m <br /> K4 Mao <br /> CONDITIONS OF PERMIT: < w !3 <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn O ! : m <br /> lL O <br /> g id C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my know& g : i <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy o all informs-. «m « m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th at this info=- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu a permit. I $� $ <br /> further accept all liability which may be a result of the County of Bumett relying on this information I am providi g in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have ` m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (sig u of o or building contractor) (date), f ; <br /> Z [ <br /> ZONING ADMINISTRATOR �L g <br /> V 1' <br /> «««�« m <br /> g <br /> TOWNSHIP PERMITS MAY BE REQUIRED I po a�" `S N <br /> �y8888 8 vmi <br />