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Burnett County 7410 Co. Pd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d P -1c <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 w <br /> located as shown herein. The ur dersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordina ice, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wiscoi isin. H m <br /> w � <br /> OWNER OO \ TELEPHONE n O <br /> SPr��E'S 4r Sa.O KI p <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME C(,Y-S L• �> 1[\ <br /> LEGAL DESCRIPTION (see tax rece pt) <br /> CONTRACTOR Q <br /> TYPE OF PERMIT(S): DWELLING/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT_ SUBDIVISIONo a <br /> / /� �7 7 <br /> STRUCTURE/ADDITION USE: 24ul f-Itta, t C�WWt3/�(s'R92.`�'f� � (-e. <br /> Hom /Cabin;;C�cial Business; Bedroom; Deck;etc.) z o 1.e <br /> 0 0 <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 we II (W), septic tank (ST),and drant leld (D17. !, <br /> 3. Show dimensions in feat of t1 iefollowing:(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. C } <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. O o <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED.1p <br /> 1I a m <br /> PLOT LAN o p n <br /> m � r <br /> a <br /> ? <br /> it- <br /> 0/3 3a '" <br /> 5 �- <br /> r <br /> 0 <br /> D, <br /> 0 <br /> av <br /> o ' <br /> 18 <br /> ND.ti� m <br /> oD O fir,1 <br /> vv <br /> M D <br /> m <br /> '—a g' y <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F - <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ 9 <br /> 3. NO GRADING OR SHORE NO ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. c' ` O "" In <br /> o :Oi <br /> O <br /> I declare that this application(including any accompanying schedule)has been 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- «r y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be to lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I a <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 havei Q o <br /> access to the above described I iremises atareason time for the purpose of inspection. _nE 3 0 RL to <br /> SIGN HERE <br /> (s' at re of owner or -i ng contractor) (dateN <br /> x <br /> ZONING ADMINISTRATOR - <br /> X <br /> xra w�g a T <br /> TOWNSHIP PER ITS IIll BE REQUIRED :8 � � ��g(N m <br /> 000ygy <br /> x x x <br /> Fs <br /> 0 <br />