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of , OaI <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S 'a f o <br /> APPLICATION FOR - LAND USE - PERMITS . _TO THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> g by application for r 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 o <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and L <br /> regulations of the State of Wisconsin. o <br /> m m <br /> ° m <br /> OWNER L)Eq hi0 I.V/ TELEPHONE E <br /> ADDRESS I (Q3 ��d 1 i /t . 1 L, LN . AMIDNER , Mn . SSoy <br /> 3 m ° <br /> V TT n( <br /> EMERGENCY/FIRE NUMBER ROAD NAME rT <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 <br /> J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION '�a p —y-- <br /> ��..'' � o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ° 1 <br /> STRUCTURE/ADDITION USE: g g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 c <br /> m <br /> a <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). W <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (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. <br /> r <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. 1I o y <br /> PLOT PLAN Z c <br /> o n <br /> M 9a a <br /> C = I <br /> f4TCAC 14rz o - <br /> I <br /> y <br /> ,rl <br /> 10 m <br /> 0 <br /> a <br /> _ <br /> m <br /> O y <br /> ° <br /> J <br /> l <br /> I <br /> x mmvm� nn ro <br /> m <br /> CONDITIONS OF PERMIT: o Z ? goo m ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 2 m c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f ' : T y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn m <br /> 8 E ° C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl. E o'o C <br /> edge and belief it is true,correct and complete.1 acknowledge that 1 am responsible for the detail and accuracy of all Informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. 25 It f, : m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. g u 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. E i m R <br /> A ,c ; <br /> 0) a A o . <br /> SIGN HERE JJJVL P4 <br /> Isigirtature of owner orIn d <br /> ZONING ADMINISTRATOR <br /> TOWNSH PERMITS MAY BE REQUIRE ' h l 3 I{ N o o m <br /> I 8 998ai <br />