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C� caY <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m 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 Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 5 <br /> regulations of the State or Wisconsin. <br /> w m \ J <br /> OWNER TELEPHONE n O <br /> 1c�ll L.I O ' CoNnlEl2 _ _ E <br /> o <br /> w <br /> ADDRESS /_ S-TPNrQPD , P H v S510-5 <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> 'm <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o C. <br /> �// w <br /> STRUCTURE/ADDITION USE: �n l T�77�L + �I��� rT -� o <br /> (Home/Cabin;C mmercial Bu ness;Bedroom;Dyck;etc.) Z o <br /> O V <br /> } <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 (N),septic tank (ST),and drainfield (DF). J g <br /> 3. Show dimensions in feet of thefollowing:(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. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> �I Z a <br /> PLOT PLAN A p o <br /> � wo <br /> C <br /> M <br /> M tom; <br /> �ACN�4 C^ <br /> 0 <br /> 0 <br /> We <br /> I <br /> 0 �cnvtn� sagv <br /> m. an '- 'ao _'ao m <br /> CONDITIONS OF PERMIT: g m- Z Co 0.0 7+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zoo <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> g V : C <br /> I 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.I acknowledge that I am responsible for the detail and accuracy of all informs. <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- 7i s f p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ig 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 w <br /> access to the above described premises at any reasonable time for the purpose of inspection. : i a <br /> m € vA <br /> SIGN HERE <br /> (signet re of owner r Ildl con P <br /> ort C- , a <br /> i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED APR - 7m <br /> CCM <br /> �. I <br />