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p � , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 9r 0 0 <br /> 3 <br /> APPLICATION FOR - LAND USE - PERMITS ' <br /> 0 <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 <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. <br /> L) / L� c m <br /> OWNER I�Yaon ,./C h � TELEPHONE /� <br /> ADDRESS/� /36 Di- <br /> aer li//1Y. V7 /ijnh(D_ TJ '1�2el (o <br /> EMERGENCY/FIRE NUMBER ROAD NAME 4 ee /Cy Cr <br /> LEGAL DESCRIPTION (see tax receipt) /D f � C.1 /" � <br /> L l_� <br /> CONTRACTOR /K//// / <br /> e rya �uhJ f- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p /�� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° ly <br /> L ] .: <br /> STRUCTURE/ADDITION USE: L"`6 OY �Yh o' <br /> (Home/Cabin;Commercial Business; Bedroo ; Deck;etc.) Z v <br /> r <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)buildingto center line of road,(c)building Q� <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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in a m <br /> c <br /> PLOT PLAN n o 0 <br /> J tie Cf / / QG �1 Lo Q <br /> CW <br /> M I <br /> M w <br /> I <br /> sZ <br /> ^� a <br /> m <br /> n_ <br /> 0 <br /> rop\ <br /> 0 LJCL <br /> 0 <br /> O � <br /> N <br /> +�1 Z <br /> f <br /> G <br /> D N Nvf� rD D � <br /> Co 3 <br /> CONDITIONS OF PERMIT: <_ m N o 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E T12 a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =1 m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m n OC <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m 6 m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa w m u <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O ut o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 R <br /> 3 x <br /> A a m <br /> SIGN HERE _ N 1 N <br /> w n <br /> (sign of owner r building contractor) D �— (datej ? <br /> ZONING ADMINISTRATOR bvuMjuI $ <br /> TOWNSHIP PER ITS MAY BE REOUIR � � j ItC N ef <br /> o o S m <br /> cmn <br /> C. <br />