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61 V OZ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <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 0 0 <br /> regulations of the State of Wisconsin. a m <br /> OWNER �aF/�2� IV. /- <br /> ��FJ C(��/�/G.- \/TE�_LEPHONE X`_n��.- �E <br /> ADDRESS a� 7 , C t VF�� `l�� Opp Gft- P'll"�.( • l I V 'f U m <br /> J�p ^ <br /> EMERGENCY/FIRE NUMBER a '� ROAD NAME A ,Jd <br /> -7H1C.0 Sw , 3r�f 3> - ? B+NaSdi�r o oeT#� <br /> LEGAL DESCRIPTION (see tax ecpiplL- <br /> srlD sv }} N �, a ��ua1-7 <br /> CONTRACTOR 0 C(j f C v.vr_ - ld- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE V ADDITION o <br /> n L) <br /> SANITARY —0— PRIVY FILLING/GRADING CAMPING UNIT —d'— SUBDIVISION '- <br /> STRUCTURE/ADDITION USE: v <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) o 0 <br /> 0 <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). ° <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building O <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o m <br /> 1A 2 c <br /> p n <br /> PLOT PLAN <br /> o <br /> r � <br /> 0.3 <br /> I <br /> E 3 B A-2 VL/ <br /> Ac <br /> L f!e ua5 C� &42",c I <br /> 0 <br /> rd �� 1 /�e ,�s ,` <br /> of 20 siva) 6A <br /> � <br /> ?SEP wfd1� <br /> e A or- re <br /> __� �/ �_ _)ftLK y <br /> p.c �go <br /> D <br /> �16-�fQ m - e m <br /> � RC2E a gg: ac� 8'= <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. q <br /> C€ gg <br /> 5 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl i R : N O M <br /> edge and belie/it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- 8 it - <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue • permit. I $� $ <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 r n time for the purpose of inspection. m ? f <br /> M a <br /> m <br /> SIGN HERE 1 <br /> (signature or uildinq contractor) _�- ��� � �� � � 9 25 <br /> ZONING ADMINISTRATOR _- o N 4. <br /> $ N ; <br /> TOWNSHIP PERMITS MAY BE REQUIRED f,\ SEP 12 egil 8 <br /> 888988 <br /> I <br />