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I f <br /> Burrett Copty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admini rator 5 m E o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m ° <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 requirement 5 of the $ <br /> Burnett Courcy Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laivs and _. <br /> regulations of the State of Wisconsin. w et <br /> w m <br /> n <br /> OWNER Odes, TELEPHON 3� O�3 G�_ Cf � o <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) t <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> A c) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> �""�7 — <br /> a � <br /> STRUCTURE/ADDITION USE: ° <br /> Home/Ca ' ;Commercial Business;Bedroom;Deck;etc.) Z o �` <br /> o <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). L(' <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). I(_�) <br /> 3. Showdimenslons Infest of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c) building <br /> I I <br /> measurement to the ordinary high water mark of lake,stream,or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SUED. 7i a w <br /> �i Z cc <br /> PLOT PLAN ° <br /> M o <br /> P � <br /> M <br /> 1 <br /> VJ m <br /> m <br /> rY ° <br /> 0 <br /> o <br /> 0 <br /> m <br /> o <br /> fnl <br /> Y <br /> z <br /> f <br /> r�lvyrjaaom <br /> n <br /> e D FL f 0 <br /> CONDITIONS OF PERMIT: <.m' ? `� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o': �Q1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c F o ' =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. G1 m <br /> i �-B � O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- O !i C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of 11 informs- 15 15 m"' T <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize the this infor- i B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. <br /> further accept all liability which may be a result of the County of Burrett relying on this information I am providin In this ap. <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps n to have O p <br /> access to the above described promisee at any reasonable time for the purpose of inspection. m : e <br /> SIGN HERE <br /> (signature o nit r bldlMc n to (date) <br /> ZONING ADMINISTRATOR - $ E i <br /> a �+rw <br /> TOWNSNIP PE MITS MAY BE REQUIRED o (n1 N N Yi m <br /> $ i�$$ 8$ w <br />