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u� (�Ti) , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m 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 m c <br /> -� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Cc <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0 <br /> regulations of the State of Wisconsin. = o <br /> S o O <br /> OWNER 'DAZL- TELEPHONE 14&Me <br /> ADDRESS � �/2ro // /YSS£nt /SC-�/ �!y i� ""�•xC17T i'S02G �Q.� � <br /> EMERGENCY/FIRE NUMBER Zz� // ROAD NAME /4SSZAt <br /> LEGAL DESCRIPTION (see tax receipt) y IVF- <br /> � C * <br /> CONTRACTOR AQr—"FS 7 S��D�� (�;,YS T, fi <br /> f\ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING _ GARAGE/ACCESSORY STRUCTURE %� ADDITION p Z: <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 3 <br /> � 3 <br /> STRUCTURE/ADDITION USE: � � , <br /> o � <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc-) Z m <br /> a o <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 (W), septic tank (ST), and drainfield (DF). 0V1 <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building O <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. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 <br /> PLOT PLAN z <br /> Ap a <br /> o� <br /> L-dY 37t1 GA2 A�r� <br /> r o` <br /> . '7N <br /> n c - —� <br /> G� � N= <br /> lVINR1CiK / <br /> w <br /> z <br /> M <br /> _ cam.> > � aeF m <br /> Dg� am a =1 <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =m y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> N € �� In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- oC <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infon v eD In <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I `$ <br /> further accept bllity which may be a result of the County of Burnett relying on this information I am providing in this ap <br /> plication.Is <br /> e t permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to ih abov described premises at any reasonable time for the purpose of inspection. r 3 0 <br /> m : v <br /> m m A <br /> SIGN HE <br /> (signa�f owner or building contractor) (date) <br /> 0 <br /> ZONING ADMINISTRATOR /.m �7o11)IG <br /> .nww--wv,rw�.n "n <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N NT n N N p m <br /> $ $ g $ $ $ $ $ vi <br />