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Burnett County 7410 Co. Rd. K, No. 102, Siren,Wi 54672 Office of Zoning Administrator m C c <br /> APPLICATION FOR — LAND USE — PERMITS2 <br /> Y C <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr bed and v v <br /> located as shown herein. The undersigned egress that all work shall be done in accordance with the requiremai Its of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the aws and _ <br /> regulations of the State of Wisconsin. m <br /> m y <br /> O <br /> OWNER .0 c_ r b TELEPHONE L �C�._ '0 <br /> ADDRESS '� `J - (WC-74-1 o p; <br /> EMERGENCY/FIRE NUMBER ROAD NAME �50D Y.l <br /> LEGAL DESCRIPTION <br /> (.Seetexr ipq` A- �C(y'�IAA.f 4` 1V ouY" Ayes I �/� Y/n <br /> CONTRACTOR _1 T �/ \ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE ADDITION o 1 (((e, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o. o �A <br /> o <br /> STRUCTURE/ADDITION USE: V' 4M-C- o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z T <br /> o O <br /> a <br /> w <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 Non It (N). <br /> 2. Show the location of the well (N),septic tank (ST),and dralnfield (DF). g <br /> 3. Show dimensions In feet of thefollowing:(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. G <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl nod and 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. ' a rn <br /> PLOT PLAN —' — z `o <br /> SCI hx/6 �� ¢ N <br /> �. <br /> /ooy <br /> 0 <br /> O <br /> m --J <br /> m <br /> w <br /> I n <br /> D 2� . <br /> I <br /> V <br /> nom <br /> CONDITIONS OF PERMIT: � �3'' Z C g� M <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a 1.? 4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- ' <br /> edge and belief it is true,correct and complete.l acknowledge that 1 am responsible for the detail and accuracy of I informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize ih t this Infor. p <br /> motion I am providing will be rallied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ <br /> further accept al liability which Way be a result of the County of Burnett relying on this information I an providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized Per ion to have <br /> access to the above describ p onflas at any reasonable time for the purpose of Inspection. r <br /> SIGN HERE <br /> (�I re of or building contractor) (date) r� <br /> ZONING ADMINISTRATOR aa. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 888888188 fmn <br />