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0,)C�),Ap <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m M0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> o TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 5H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m OC <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. y o <br /> m � <br /> c <br /> TELEPHONE <br /> ADDRESS y �(� G(M('A '�r(� l �a CU1Lo inf -1.11 '5Aoy m Q� <br /> EMERGENCY/FIRE NUMBER / �� ROAD NAME [3 VLe_k)/ Qn�/fZ <br /> LEGAL DESCRIPTION (see tax receipt) /�,% C?]m V e r' ' I 1 /_12 )9 <br /> CONTRACTOR 'T� C / P e c _ <br /> TYPE OF PERMIT(S): DWELLUING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONS p <br /> n 0 \ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> `^ r <br /> STRUCTURE/ADDITION USE: act _ o °- <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> o ° <br /> v �`l <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 7 IZ4-- <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). I 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 <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o rn <br /> c <br /> PLOT PLAN o a <br /> fn o <br /> C <br /> 4- <br /> 17�1 <br /> I <br /> m <br /> i . <br /> r� <br /> � C <br /> / N <br /> Ld <br /> ' h1 <br /> 12- 1 <br /> Zt I o <br /> S,-13-93 Y)- <br /> ^ , <br /> wee Rdd ,-6cY) <br /> / pC(iT1iT -> 13Gi��(o A C 2.am g m MM <br /> 'oCONDITIONS OF PERMIT: m N. C ii .0 : <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c o � 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =N y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - N G)2 ` : m <br /> [ $Er € A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o I C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- •^w>; T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o18 o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> T 3 0 <br /> a <br /> m m A � <br /> M m 0 [ <br /> SIGN HERE - <br /> ($i ture f owner or wilding contractor) ( <br /> ZONING ADMINISTRATOR I 0 <br /> a.. <br /> Io <br /> + N N W N to V <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N m <br /> 000000 ON <br />