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6y) (�-Vvp , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <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 3 a J <br /> regulations of the State of Wisconsin. <br /> m <br /> n £O <br /> OWNER . TELEPHONE <br /> n P ky) Tit Soo- <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER L ROAD NAME . ,/1.eit Tc, Itd to 44 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGt1d0&(-G GE/ACCESSORY STRUCTURE ADDfTION o <br /> n G1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> �^ r <br /> ��w , 0 0 <br /> STRUCTURE/ADDITION USE: �'U� <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> �oj` a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) n <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 0 Y ° <br /> 3. Show dimensions infeet ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building -1 <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 C, <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 o r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. oo 3 m <br /> on Z v <br /> PLOT PLAN I p� O cn <br /> ' fn % <br /> C <br /> u �e <br /> fs 5� 6,� <br /> S 1. o <br /> 5eP c <br /> � <br /> " <br /> Noa �� <br /> a <br /> N <br /> 8µ' <br /> M <br /> e��imo aim <br /> p'my <br /> D m 0 — <br /> CONDITIONS OF PERM-17-- A- (, `0 5.5.: 'Z CS ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUAN TCCy o f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r= S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. b 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 m C <br /> of al <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy t informs- J <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inlor- B g : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0`8 $ <br /> further accept all liability which may be a result of the County of Burnett retying 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 O N p <br /> access to the above described premises a ny reasonable time for the purpose of Inspection. T 3 'oo ; <br /> N V A N <br /> SIGN HERE 1 r^ `B <br /> (signature o wne or ilding c/pntractor) 'd' <br /> N �� <br /> ZONING ADMINISTR N. <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N o p N m <br /> 00o � 000fmA <br />