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ON COMPUTER/SCANNED01 amp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator gm o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3. a <br /> regulations of the State of Wisconsin. y �. <br /> c <br /> OWNER \---. ....)\-e\ <br /> /"I����� \ TELEPHONE --?1_S- �."-W- a��4 a T O <br /> �-( v <br /> ADDRESS rd-.7.2V-ci g.(.1 \ C^!'eeC C-..Z `)Sic <br /> EMERGENCY/FIRE NUMBER Sj/'�, ROAD NAME c9(42 0 o l�( p U v6 414- ('1� <br /> LEGAL DESCRIPTION (see tax receipt) i <br /> 1 <br /> CONTRACTORn <br /> 7' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING lk <br /> A GARAGE/ACCESSORY STRUCTURE ADDITION ) O <br /> SANITARY Ix PRIVY FILLING/GRADING CAMPING UNIT/ SUBDIVISION <br /> r <br /> STRUCTURE/ADDITION USE: a (,( - '(i:).�. - l <br /> (Home/Cabin;Commercial Busi ss; Bedroom; Deck;etc.) z 3 <br /> 0 0 <br /> rr— <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 (W),septic tank (ST), and drainfield (DF). 0 <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building II U <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 M <br /> dated by the owner. c o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 -6 N <br /> II Z Q <br /> PLOT PLAN 16o a <br /> M <br /> ct. (/ <br /> IA <br /> 111 <br /> 17) <br /> C, <br /> �; <br /> IA <br /> 8.J <br /> N <br /> 0 <br /> to <br /> v -I <br /> N <br /> CA) <br /> \.J <br /> Z <br /> i ± <br /> 33 r�rp-0tnr>DO -0 <br /> ooc ..0sSQf m <br /> m. , � day r: m >7 <br /> CONDITIONS OF PERMIT: a < N• C o = co = <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o. T-• -I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ XI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �� o 3 2 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ;t> o . m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- -L. " u►IT EA m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 sa 8 p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0 i 8 <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 o O <br /> access to the above described premises at any reasonable time for the purpose of inspection. CO m <br /> 3 <br /> T y <br /> W <br /> N N <br /> SIGN HERE 0. <br /> (signature of o e or buil i all rector) (date) o <br /> 11 0 <br /> ZONING ADMINISTRATOR ' 0 <br /> \lam ,, b ER u► H EA to t» m <br /> TOWNSHIP PERMITS MAY BE REQUIRED ( 8 51 8 m <br /> 80 8888 tmn <br />