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Burnett County 7410 Co. Rill. K. No. 102, Siren,WI 54872 Office of Zoning Administrator f O <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o c <br /> located as shown herein. The u ned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinal ,Sanitation Code, and with all other applicable County Ordinances and the laws and o <br /> regulations/of the State of Wisco sin. <br /> OWNER L {2® / Q, q .S,S�JV TELEPHONE 7/-6 <br /> ADDRESS a © n [.v F,'{fC(/ /C Fes• r" <br /> EMERGENCY/FIRE NUMBER �2 6 Q r ROADNAME <br /> LEGAL DESCRIPTION (see tax ret pt) <br /> CONTRACTOR NV A 47v•e. <br /> TYPE OF PERMIT(S): DWELLING/ UILDING RAGE/ACCE _ STRUCTURE ,ADDITION <br /> PRIVY {�r�iI1PT(J� o a <br /> SANITARY FILLING/GRADING CAMPING UNIT SUBDIVISION o �- <br /> // �/ y �s y 'x <br /> STRUCTURE/ADDITION USE: <br /> ora e �Jyonr.` f Lrq ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I <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 II (W),septic tank(ST),and dralnfleld (D17. <br /> 3. Show dimensions in feet of hefollowing:(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 subMI tied by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STA Ia=D FOR ONSR ON BEFORE A PERMIT CAN BE ISSUED <br /> y..- 11 Z v <br /> o n <br /> PLOT PLAN 100 <br /> C . <br /> I <qoSU <br /> S > a <br /> 41"— <br /> r <br /> W <br /> o pe ' <br /> �gb s o <br /> G <br /> I <br /> CS83 <br /> CONDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST ME DRIVEWAY WIDTH R OUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. cy <br /> 2. REMOVAL OR CUTTINGOF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? , O X g <br /> ; ? n <br /> 3. NO GRADING OR SHC RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4E ? L : ` <br /> kn <br /> Si <br /> I declare that this apDllcatl (including any accompanying schedule)has been examined by me and to the beat of my curfor J M M i j <br /> edge and belief it 16 true,co rro ct (including ae. accompanying schedule)and I furthesible �that I am resPOnrdsclars the that 1 recogneze t ail and tltnis�n 08- $ i t <br /> lion contained in this aDP <br /> motion 1 am providing will relied upon by the County of Burnett Wisconsin in determining whether to issue <br /> further accept all provliabiliding <br /> ll ich may be a result of the County of Burnett relying on this information I am Providing In this a 0 <br /> plication.I agree to permit ounty officials charged with administering county ordinances or other authorized person to haw <br /> access to the above sen promises at any r*asonsbl*time for the purpose of inspection. <br /> M; <br /> SIGN HERE (date) <br /> (sig u of own* building contractor) . <br /> ZONING ADMINISTRATORi. <br /> TOWNSHIP ERMITS MAY BE REQUIRED 8 $8 8 81" i$ <br />