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chl�o <br /> Bumett'County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <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. <br /> bi <br /> w � <br /> OWNER Aj,VIAI 1<1RA7—ZA�- L2, TELEPHONE n O <br /> ADDRESS -�0Q GUICT• J AT rO R O loW j - 'S4 nq a <br /> ) <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) I <br /> CONTRACTOR <br /> J <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION n I o <br /> /r = 0 <br /> SANITARY <br /> PRIVY FILLING/GRADING CAMPING IT BDIVISION o <br /> STRUCTURE/ADDITION USE: '�"".1 errn <br /> (Home/Cabin;Commercial Bu ' ess;Bedroo ;Deck;etc.) Y z {Iy�TVI <br /> o 'o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } <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 draiMield (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. <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 7t 3 y <br /> �I Z c <br /> PLOT PLAN <br /> M �4 <br /> c <br /> 0 <br /> ° I� <br /> v � <br /> 00, <br /> N <br /> n If ` I <br /> vw <br /> 2 <br /> f <br /> catv' �- a» EE° M <br /> ,CONDITIONS OF PERMIT: g m- .Z C o 0 m X <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o �'2 1 <br /> o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p T <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' In j [ fl D <br /> g : <br /> roc <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- ' ` O m <br /> it jai <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- to : G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> 80. g <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 o <br /> access to the above described premises at any reasonable time for the purpose of Inspection. a ,°, <br /> 980 <br /> u A <br /> SIGN HERE a' ` <br /> signatu of owner or building contractor -- <br /> t o <br /> T� Flan _ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED NOV - 2 QO2 0 u o o m <br /> 888888rn <br /> lJ U <br />