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on ccnyl'�p, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and rn o <br /> m c <br /> located as shown herein. The ur dersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and _ a <br /> regulations of the State of Wisco Ism. H m 1 <br /> N � <br /> OWNER 5 TELEPHONE lam]/ -2 <br /> l t[� Cts v ,) <br /> ADDRESS I L/ 3 (� , r �r(LA' �� ' V m 1 <br /> EMERGENCY/CRE ROAD NAMEC�I 1 <br /> LEGAL DESCRIPTION (see tax race pt) P� u /T 3/ sec I It v Nf_ R' Li <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION�� p <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: Te <br /> ` ` m o <br /> Home/Cabin;Commercial Business; Be m;Deck;etc.) <br /> O ° J <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 (Vi), septic tank (ST), and dralnfield (DF). g <br /> 3. Show dimensions Infest oft efollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -q <br /> measurement to the ordinar I high water mark of lake,stream, or river. Q <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 ur <br /> PLO PLAN ltrx r N <br /> UTJ ir <br /> r ( o <br /> f G <br /> i <br /> 0 <br /> 1 o' <br /> _ <br /> o <br /> POv <br /> a� -7T —f <br /> la c 1 <br /> 1 J 9 <br /> 1 <br /> 1N��1 <br /> )CR-1�c, -11"vtaJ rte w �l <br /> n10 13a+►.roo Al �,p<<h b-¢, ao 'x 0-9 <br /> 3 S� ■y" A c<�d r O>o f m <br /> CONDITIONS OF PERMIT: ^ m - CS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — M <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" o: 0 <br /> If r <br /> I declare that this application(ir eluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,coffee and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a)' <br /> m <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- $ iii ; p <br /> matlon 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 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 coun y officials charged with administering county ordinances or other authorized person to have O N p i� <br /> access to the above described iremises at any reasonable time for the purpose of inspection. ' m ' <br /> 8 Rmt�, <br /> 9 O <br /> m m <br /> SIGN HERE �- <br /> ( a0yre of owner or uilding contractor) (date) i $ <br /> � v <br /> ZONING ADMINISTRATORx- <br /> q>yX2�C;yy]2�X�t <br /> n `nNNN XJK JK <br /> TOWNSHIP PERMITS MAY BE REQUIRED m96000 $ «««fn <br /> 0 <br />