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.R County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( m o 0 <br /> APPLI ATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and <br /> located as'shown herein. The u idersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordin ince,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> '3 n <br /> regulations of the State of Wiscc nsin. y <br /> 41 N rl <br /> n O <br /> OWNER �0.WLe j L ClL\ t� `'�/� C I TELEPHONE (� 12 — fiI— I0 11 <br /> 1 <br /> q c- 1 <br /> ADDRESS (Oi-I (J�) 1111C' - cl S� PIA.J Vv� .SS"II m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> r <br /> LEGAL DESCRIPTION (see tax receipt) rr ^ <br /> CONTRACTOR <br /> YYY.•���eee _� <br /> TYPE OF PERMIT(S): DWELLING/31-11—DING GARAGE/ACCESSORY STRUCTURE ADDITION. p �� <br /> n G1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a 0 <br /> STRUCTURE/ADDITION USE: Re IoC.:.t 0 '4 Intl.. ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck,etc.) z m <br /> o ° <br /> a <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 thew II (W),septic tank (ST), and drainfield (DF). C o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building I r <br /> measurement to the ordinary high water mark of lake, stream, or river, p <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 (a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> PLOT PLAN C zI a <br /> t I\ ( l o n <br /> out m <br /> C �4 <br /> m kJ <br /> O ry <br /> L/1 <br /> y <br /> f <br /> Fey <br /> I _ <br /> I O p <br /> aJt`w� t• �� I � � <br /> i O <br /> N 9 Yw <br /> f2X2+� 7S0 t -17—Its <br /> _ t <br /> y7XW ..10_ i� I <br /> J <br /> c-0 W r tDi o f <br /> �. -g �2.ayamm <br /> e _ �o <br /> CONDITIONS OF PERMIT: '1al^''� /��1\�" �� m K: Z $ pro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =0 i�i M <br /> 3. NO GRADING OR SHORE N ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o n p <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- o i i C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- H m 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 /> further accept all liability whict 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 p <br /> access to the above described premisesa any reasonable time for the purpose of inspection. 3 b ; <br /> a u e <br /> SIGN MERE I ti <br /> sin re caner o ding contractor) ,� detej--- � - x <br /> ZONING ADMINISTRATOR x - <br /> 0 ' x <br /> TOWNSHIP PERMITS MAY BE REOUIREO U-1' 0 0 0 8 y <br /> X x x <br /> 0 <br />