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II ) ("Clyr <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c " o c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby by makes application for a Permit for the work described and Zr <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. 1 <br /> rn d <br /> OWNER Y1 f)D L�)N G D o K TELEPHONE n 0 <br /> 1'1 R o <br /> ADDRESS 100 VIN AV - S-f ST- CLoVo MN <br /> � S63n <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING U SUBDIVISION 0 o <br /> �Y���Y���� o <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Co mercial Business;Bedroo ;Deck;etc.) Z v <br /> 0 ° <br /> 0 <br /> 1 <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). — o <br /> 3. Show dimensions in feet of thefoliowing:(a)buiidingto all lot lines,(b)buildingto 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 A <br /> dated by the owner. O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED 0 y <br /> PLOT PLAN o a <br /> M <br /> AiTA(,W'o <br /> m � <br /> w <br /> C C <br /> t <br /> AI cn <br /> Q_ n_ <br /> VV o <br /> 0 <br /> o y <br /> I <br /> XI Z <br /> S <br /> C <br /> O C dN 6 O D <br /> a <br /> CONDITIONS OF PERMIT cH o 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 ? -� ? i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - m <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, Yrn O <br /> 8 E : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o . m ii m <br /> � : <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa. .n m <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. 1 8 m g <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- in <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have . 000 ' <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> a <br /> (signet a o\f.owner <br /> rr L building contractor) l\,(� �..- (date) <br /> ZONING ADMINISTRATOR .� )Im I ort,),h <br /> TOWNSHIP PERMITS MAY BE REQUIRED SEP - 9 ` �� o N n n o o dN _Mn <br /> 888 8889 a) <br />