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N <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator m m a o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 3 n <br /> regulations of the State of Wisconsin. – o <br /> N Yl <br /> N � <br /> ,n C <br /> OWNER A ! IJ ��„ 1= TELEPHONE ��j �+rGL2 0 <br /> ADDRESS g9ty''IIOra I Aj 4i/ 70 1(A-)i \ <br /> EMERGENCY/FIRE NUMBER ROAD NAME �I <br /> Mt, 3(,– 'L3 Uv�1 /(o — 536 /T34 /l ll�rJ 0. P�5�1.0Vu <br /> AI <br /> LEGAL DESCRIPTION (see tax receiptL-*M' /� ,Sb biS6o LOT 2 CSM ✓(a ft u V bT 5 <br /> CONTRACTOR C L f m <br /> 111 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p _ <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION — 0 <br /> o < <br /> STRUCTURE/ADDITION USE: r <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> 0 0 <br /> v <br /> m <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 dreinfield (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 M <br /> dated by the owner. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a N <br /> PLOT PLANZ <br /> A o n <br /> m o <br /> CO Aj. a Pew f s c Ji <br /> eu <br /> N <br /> N <br /> A <br /> } O <br /> 0 <br /> 1j <br /> 0 AVAvI <br /> O <br /> k � <br /> \ <br /> rin <br /> CONDITIONS OF PERMIT: Sit S m g Cy qwq o' 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o �Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> c1 2 : rn <br /> 0 : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- e,y«, m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> 919 o <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«i <br /> access to the above described premises at any reasonable time for the purpose of inspection. o m <br /> m ' [ v A 0 <br /> m m 0 <br /> SIGN HERE in o ` <br /> (sign of owner r uilding contractor) Fr I <br /> ZONING ADMINISTRATOR <br /> � a $ E <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N o � � N m 00000000 m <br /> 00000000 CA <br />