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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 /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and mc � <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 _ n <br /> regulations of the State of Wisconsin. <br /> m � <br /> 111 / / G c <br /> V�11,11Av� 4 O l_ v-\rlo, lD�� �F OCA S9 <br /> 1 0 M <br /> OWNER TELEPHONE n f <br /> /A� m_ <br /> ADDRESS ( AV�V rn S�0� m77, <br /> EMERGENCY/FIRE NUMBER N'a— ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR , �mk vl,� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION O ^� <br /> o , J <br /> SANITARY PRIVY ILLING/GRADING CAMPING UNIT SUBDIVISION o` 4C <br /> 0 <br /> STRUCTURE/ADDITION USE: CD 1yil <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <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 (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,(c)building 1A <br /> measurement to the ordinary high water mark of lake,stream,or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and p <br /> dated by the owner. l/ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a m <br /> PLOT PLAN 1 .� �jt r ,1 � ^ 1/ _ (� <br /> o n <br /> (j��� <br /> C I � <br /> G� m , <br /> OPva <br /> 0 <br /> 4 � <br /> C <br /> 01r <br /> I � <br /> 9 er ravmr DD 17 <br /> m 0.� ' noagm <br /> as - _ M <br /> CONDITIONS OF PERMIT: ^ g z• i Z C o 0 o ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 0 o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. :'E 9 <br /> M = 4 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ( tli G) .m <br /> 8i <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.I acknowledge that I am responsible for the detail and accuracy of all informs- °c m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i g m u, : m <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I $u $ <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 ; N <br /> access to the above described premises at any reasonable time for the purpose of inspection. ` m <br /> m E 3 $ r <br /> � <br /> m [ : A m . <br /> SIGN HERE `r ,^' <br /> (signature of o or u ing co or) C� a /7 `�; �{ a ; '• <br /> sn 8 € <br /> ZONING ADMINISTRATOR <br /> wi i <br /> TOW SHIP PERMITS MAY BE REO 14D-- <br /> D1%] MAR 17 " <br /> N J U U O O <br /> i 888888 <br /> I— <br />