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y, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> ' m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. w a <br /> m et <br /> c <br /> OWNER $PUD�F ►U TELEPHONE aOs_ SDI <br /> I <br /> 1 I 1 0 <br /> ADDRESS N7M 210-Ik ST- WIC111 ELD MN ';SOS'7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) •N\r.•�f l <br /> CONTRACTOR LYS / �ij <br /> ` l <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION T" p <br /> 0 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> 0 0 <br /> a <br /> m <br /> 3 <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 (DIF). I� <br /> 3. Show dimensions in feet of thef011owing:(a) building to all lot lines,(b)buildingto center line of road,(c)building O <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 4 <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> PLOT PLAN n o_ a <br /> M y <br /> C <br /> ' ' <br /> M o0 <br /> 0 <br /> 6 <br /> V N <br /> WOW <br /> I o <br /> N <br /> O <br /> b <br /> O � <br /> w <br /> z <br /> s <br /> D N N S N r ➢ D m <br /> � ° g� > > � a � m <br /> CONDITIONS OF PERMIT: <br /> o m S ,2 goo 0. ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Fon <br /> D* 0 ,2 D <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = ^t I m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. mi <br /> g o , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m 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 w 1 <br /> tion contained in this application(including an accompanyingschedule and I further declare that 1 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 mvI p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 8 <br /> SIGN HERE <br /> (sigillature of owner or uin n ra L <br /> o : <br /> ZONING ADMINISTRATOR <br /> U IUD <br /> JUN 0 U IUD <br /> N i i i i <br /> TOWNSHI PERMITS MAY BE REOUIRED I` N H ' <br /> N .i O N O .8 .8 m <br /> U 8888888 v, <br /> I <br />