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0i-5 Inrw <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator P1 77 " �! <br /> m 0 <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 1- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the mm �. <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 /> rn d <br /> m g <br /> c <br /> OWNER MILES SPAFfoRD TELEPHONE n10 <br /> ADDRESS ZI J 2 2n SPAffoRo Ro p�sTe(� 'Fol - <br /> EMERGENCY/FIRE <br /> A�l �{g�3 <br /> EMERGENCY/FIRENUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) (-(� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> m <br /> STRUCTURE/ADDITION USE: ii or. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m <br /> 0 o W <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 7 <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)) «Jff,,l <br /> 3. Show dimensions infest of the following:(a)building to all lot lines,(b)buildingto 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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 o y <br /> PLOT PLAN Z Q <br /> Fob � Ir��d��— m o <br /> P� <br /> -41 <br /> mPit i <br /> aTmwev c� <br /> QJQ <br /> LJ N <br /> 0 <br /> N <br /> O <br /> J <br /> O <br /> b <br /> � y <br /> N <br /> 2 <br /> I <br /> D O c W r n a 0 m <br /> m <br /> m - g� amamm <br /> CONDITIONS OF PERMIT. v m<. c S 0 5 <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. �.z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p f ' ' zt ur i y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. RC';2 m <br /> g <br /> IF <br /> —' D <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : a � C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- ur a n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inior- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o'$ g <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 ONO <br /> access to the above described premises at any reasonable time for the purpose of inspection. = m m <br /> 0 A N <br /> SIGN HERE <br /> (signatu6 of owner or building con roc r) (d t �' <br /> - i <br /> tTil <br /> o ; <br /> ZONING ADMINISTRATOR <br /> M H ' <br /> MH6'1H T <br /> TOWNSHIP PERMIT AY BE REQUIRED o N N N N m <br /> $ 8 $ $ 88 "t <br /> _ o o m <br />