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CK eoy�' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <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 m A <br /> Burnett County land Use Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. y m <br /> m <br /> m O <br /> OWNERT LEPHONE o <br /> ADDRESS ..3 Q v� st A/ S5 <br /> EMERGENCY/FIRE NUMBER ` e/-v ;? ROAD NAME r <br /> i <br /> LEGAL DESCRIPTION (see tax rete pt)IDi <br /> ep!j <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWEUL4G/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION �/ O <br /> L7 <br /> SANITARY PRIVY FILLING/GRADIN CAMPING UNIT SUBDIVISIONo 0 <br /> STRUCTURE/ADDITION USE: o <br /> Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 c �' <br /> DIRECTIONS FOR PLOT PLAb DRAWING: (Aerial or top view) I ` <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 thew II (W), septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infeet of tilefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinarl 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 LOC.ATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 13 yM <br /> 11 z `c <br /> PLOT PLAN o n� <br /> <_ <br /> N , <br /> 00o_ <br /> C ' <br /> a <br /> 1 < <br /> oRicl'nlAz msT ## 1675iA i�sued� �a-�� qct00 <br /> — <br /> o <br /> J m <br /> to 0-1[off <br /> �� �Gl Ce ✓ t [7rY� t E 1 ,i <br /> U' to-0 oM <br /> CONDITIONS OF PERMIT: Z 0,O: 'Z @ g,' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> N : <br /> 2. REMOVAL OR CUTTING CF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - <br /> $ : H- <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know I- : o E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and aecuracy of all informs- '- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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- N <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized Dereon to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> SIGN HEREIV <br /> (all nit f ner or ui i contractor) (date) <br /> ure <br /> o ; <br /> ZONING ADMINISTRATOR \ ✓�/"%' <br /> M X XX <br /> �naa a�+sxw T <br /> TOWNSHIP PERMIY MAY BE REOUIRED o N pN .2 iia m <br /> 60 b, <br /> 0 <br />