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ON COMPUTERJSCANNED <br /> Burnett County7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of ZoningAdministrator g � �' 'cv z <br /> w co 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS iv <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 2 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 d <br /> C al <br /> OWNER S'-'''` t / 'EE/95 TELEPHONE a 0) <br /> ADDRESS ON 70 <br /> k V , codafs LK . Ro- V' jW:, VVI;' S93 <br /> EMERGENCY/FIRE NUMBER ROAD NAME r <br /> 1, <br /> LEGAL DESCRIPTION (see tax receipt) ` `,r <br /> CONTRACTOR <br /> TYPE OF PERM T(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: o o ii <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z <br /> O O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Q K <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). ---,, ,.. .14 <br /> uu <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). U) o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building iii us) <br /> measurement to the ordinary high water mark of lake,stream,or river. G <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. c o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 <br /> PLOT PLAN 5I <br /> o a <br /> a �'NiA.� k W--,CDa N <br /> O 0\ <br /> 3. <br /> L/ <br /> 5 <br /> co <br /> v -a <br /> N <br /> o <br /> C.) <br /> Z <br /> 47) ± <br /> NS—. <br /> C ?rc=.s e' o o. 7 <br /> v tea, 2.x2,, cm Lg <br /> Lg <br /> CONDITIONS OF PERMIT. < N. .- �C o g�' a. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m T•R —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. F5 c2i m <br /> o 0.� 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- e <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- U 4"w a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- + 8' 3 o p <br /> v <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o i o <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- 40 <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have o a <br /> access to the above described premises at any reasonable time for the purpose of inspection. w o CD <br /> I m A y <br /> N N 0 <br /> SIGN HERE L - I. garr .I C .r" r- J! l L t A <br /> (signet a of owner or it• ng c> acto i _— %.► . - ;i `� <br /> �,� x <br /> ZONING ADMINISTRATOR ,( 4 ♦/ ' �� <br /> TOWNS ie <br /> RMITS MAY BE REQUIRE J o i n N m <br /> 1 dell• <br /> OO ` OOO0 CFIm <br /> 00 000 N <br />