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kb mac,uzv ,-., cUPpa� 6g— 4-1 -q9 ✓ '1 cam , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N V -+ z <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 y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. o <br /> m d <br /> OWNER snl-i rte{ ���� TELEPHONE $ Q f <br /> ADDRESS `/ <br /> EMERGENCY/FIRE NUMBERROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> Z <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION n o <br /> STRUCTURE/ADDITION USE: /Ul n'`\ K•text , Arc./\ i,- &X'U0/74_ r}/ jP 7� �(Le o <br /> (Hom /Cabin;Commercial Business; Bedroom;Deck;etc.) flZ <br /> ° o Z <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 drainfield (DF). 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 <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 0 <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, v rn <br /> PLOT LAN e c p or <br /> m r T o <br /> C I ° <br /> 39 <br /> f <br /> Q <br /> \B <br /> pu-er <br /> --to at-1 lf� <br /> j <br /> ___ <br /> m <br /> DS a <br /> CONDITIONS OF PERMIT: - M <br /> -- v w, c - <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m 5': g ..l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f <br /> ; N; � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. mp <br /> g C <br /> I declare that this application(including any accompanying schedule)has bean examined by me and to the best of my knowl- ( , o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• «+y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i R <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determiningwhether to issue a permit. I (j <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 havenW i <br /> i <br /> Vicess to the above described premises at a reason time for the purpose of inspection. : <br /> ON0w b <br /> vA <br /> 'ERE i� �7 �+ <br /> (a net re of owner or I ng contractor) '^ <br /> (date) <br /> AINISTRATOR <br /> 8 : X : <br /> TOWNSHIP PER ITS A11AV BE REQUIRED <br /> 0088rm <br /> xxx <br /> 0 <br />