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on <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m/ l01 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the v <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and $ <br /> regulations of the State of Wisconsin. m m <br /> u o <br /> OWNER ChS Q �5 TELEPHONE327 7_ <br /> ADDRESS Zi s3 i si 41l� �Ctolere �r<o mss... 5 s7 o� G <br /> EMERGENCY/FIRE NUMBER ROAD NAME �- <br /> G <br /> LEGAL DESCRIPTION (see tax receipt) 5'y�� 5'�� S ZS -T Nom. <br /> CONTRACTOR //7 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING>— GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o` 4 <br /> m � <br /> STRUCTURE/ADDITION USE: �dtii GI-Cgy-C �- o' °— <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) _ <br /> o ° <br /> ppp' 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 (II and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DII C 5 <br /> 3. Show dimensions Infest of the following:(a) building to all lot lines,(b)building to center line of road,(c)building 41 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <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. O S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 y <br /> on c <br /> PLOT PLAN o 0 <br /> M Q o <br /> V C 9- <br /> a ' <br /> fe <br /> s r o S <br /> 0. <br /> � t <br /> r - m <br /> o <br /> z <br /> C <br /> ; YN � <br /> V <br /> 7'1 iz,- <br /> ro <br /> b w v <br /> ro R FL m <br /> In <br /> e Y <br /> CONDITIONS OF PERMIT: g ,z c g g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �1 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. � �' i m <br /> Lr <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs- <br /> tion contained in this application(including any accompanying schedule)and I further doctors that 1 recognize that this infor- 75 ; In <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ $ E <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- i ' <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 promises at any reasonable time for the purpose of inspection. <br /> n <br /> ` L7� IC:'li • i i i ! i <br /> SIGN HERE <br /> (signature of owner orIlding contr to (date) <br /> E E Ei f i i <br /> ZONING ADMINISTRATOR I Bit MA a,: <br /> TOWNSHIP PERMITS MAY BE REQUIRE ' i <br /> __--- 888888188 ymi <br />