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Burnett Cquil 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admi mistrator va) ( 9 .' z <br /> APPLICATION FOR — LAND USE — PERMITS s E o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and . w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m CO <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. o <br /> w m <br /> m <br /> c <br /> OWNER TELEPHONE <br /> NE <br /> ,L n <br /> O <br /> ko {. P—Ak D (JA) -W _ 3 OW <br /> ADDRESS / / N 6 <br /> 0fq- <br /> EMERGENCY/FIRE <br /> NUMBER <br /> SHCl <br /> turs � K <br /> LEGAL DESCRIPTION (seetaxreceipt) N a C� 1- ° 9 ROAD Iw NAME,#t <br /> [jrar- ca•CS 1 <br /> CONTRACTOR C-1,F <br /> TYPE OF PERMIT(S): DWELLING/BUILDING___ GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> c> <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: B 1 ^i o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> 0 c <br /> m <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). <br /> 2. Show the location of the well (VI),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,( building <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 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v to <br /> PLOT PLAN = o <br /> 1107- A/dle t� N <br /> � o <br /> e P T C v� <br /> ,3/�` n — <br /> �aI6" _6 <br /> D F <br /> h° ST.4 N G <br /> fJ3--�� ?'� o <br /> i <br /> 360 its� 0 <br /> 0 <br /> m � <br /> to , <br /> - - - IdU, <br /> ,Bif ck66"9/e TRF} [, To be ,vo lust.1 <br /> p <br /> 7 i u'bl tic. oz t'.'4lL ' <br /> PreSSL-e <br /> c�uTH <br /> m <br /> CONDITIONS OF PERMIT: o g FL ?ff 2.- Z c ffi g' Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F sp ' <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. Wi f gg m <br /> k ' D <br /> op ' EE <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> responsible for the detail and accuracy of all informs- <br /> tion <br /> 1 am <br /> edge and belief it is true,correct and complete.I acknowledge res - <br /> P g <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m <br /> S $ : G <br /> mation 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 Burnett relying on this information I am providing in this ap- <br /> plication. 1 agree to permit County officials charged with administering county ordinances or other authorized person to have ' p <br /> access to the abov ascribed premi at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (signs of ownet,0 building contractor) (date) i fe <br /> ZONING ADMINISTRATOR <br /> $ <br /> ar.w~r.N T <br /> TOWNSHIP PERMITS MAY BE REOUIRED 8 " N SH f>; m <br /> $ $ $ $$$ P <br />