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Bumett.County 7410 Co. qtd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> ;v o <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 u idersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinince, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n W <br /> regulations of the State of Wisconsin. <br /> WK (el)- <br /> 0 <br /> e) O <br /> OWNER TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER - % �� ROAD NAME �/9/vsc.tis' Por/V 7 Rd <br /> (r7 C <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION __ p <br /> O LSANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> ^^ `` p o <br /> STRUCTURE/ADDITION USE: (2,4tv- -/ AcW,-1 dA, h� !-8,,A&bm �/rllvl I o <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) z o <br /> a <br /> i <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). r <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions infeet of hefollowing:(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 9 1 <br /> dated by the owner. 0 0 _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> 1 L/+KE o n <br /> PLOT PLAN (,v r✓a c+ A <br /> 1 N^yy' <br /> -C <br /> v <br /> y tkr"--1144 C o <br /> D <br /> 01 - <br /> �`rzn5� <br /> eae �l ' o <br /> Co y,bwEu <br /> kW7 h> � NI a'J <br /> 161F+ To salt <br /> S 1`E� 00 <br /> —AlANS ' o/NT /�O4 z f/� Nv raaov <br /> n n f <br /> � n�' 110 M m <br /> v m 2,: 2 e <br /> CONDITIONS OF PERMIT: < u, Z �CS .0 5' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 2 : m <br /> � 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =41 <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o L7 0 o 0 <br /> I declare that this application(Including any accompanyingschedule)has been examined by me and to the best of my knowl- o P :x C <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- d'w T <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- B ; p <br /> mation I am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $i <br /> further accept all liability whit i 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 cou ity officials charged with administering county ordinances or other authorized person to have i O N o <br /> access to the above describec premises at any reasonable time for the purpose of inspection. 3b a Y <br /> Q o u <br /> SIGN HERE t <br /> (s at got owner or i Ing contractor) —=- ate( <br /> P <br /> 999 X <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE S MAY BE REQUIRE o u�N N m <br /> III,., 0 $ ,08001® ® W <br /> <» <br /> 0 <br />