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cow-P, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m a <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 m `c <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. <br /> c 1 <br /> o <br /> R ALAC <br /> m O <br /> OWNER ffu K F_R u C Z TELEPHONE <br /> T m <br /> ADDRESS .57_ Pill UL . MN. 55 1662 Ibld <br /> EMERGENCY/FIRE NUMBER ROAD NAME t <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 4:: 71 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY ^ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° ^ <br /> J <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck; etc.) Z <br /> o O <br /> a <br /> 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 the well (W), septic tank (ST), and drainfield (DF). �) <br /> 3. Show dimensions In feet ofthefollowing:(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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o N <br /> PLOT PLAN o a <br /> C . <br /> M <br /> AfACt 60 <br /> N <br /> A <br /> O <br /> N <br /> O ,, II <br /> � I v <br /> � v <br /> b <br /> O ti <br /> N <br /> V ZT <br /> X11 I ' <br /> Yl IrY<J1 1 <br /> I < <br /> CONDITIONS OF PERMIT: m Z ro r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F =N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Vi 62 o 6 2 m <br /> o ; n� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- V,)1 0 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- i d'm'^ T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- g p <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 which may be a result of the County of Burnett relying on this information I am providing in this ap- l: <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to haveO eN, p <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' m b m <br /> v o <br /> m e A <br /> N � O <br /> SIGN HERE KJmAd -- <br /> (signet relof ownery�or building contractor) I.`.r %ate)' _ ` - -8 E <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIR 3 �]� y T <br /> 0 ti/W /q+f�yU N W N N �O .r m <br /> _ rpb� {>' N O�N m <br /> $ 0 <br /> 00 , 0 <br /> rn <br /> ly 'rf. 41 y v <br />