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ON G®MPUTEwsw^Mlv`v ft�l CA,„ ,.l <br /> I�/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SM72 Office of Zoning Administrator C ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> w o <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 C J� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and a V <br /> regulations of the State of Wisconsin. o <br /> 41 C1 <br /> C <br /> 7f / C , <br /> OWNER // <br /> TELEPHONE � S {� / p oO <br /> ADDRESS �� -9 1_3 tr,?P,Y U6e/ IC6_— <br /> EMERGENCY/FIRE NUMBER { 2 7/ ROAD NAME �. <br /> LEGAL DESCRIPTION (see tax receipt) <br /> `f <br /> CONTRACTOR 4 �. <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> CD <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom; Deck; etc.) <br /> Z <br /> O <br /> m <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 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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. \ <br /> C <br /> PLOT PLAN Zo Cr <br /> C <br /> rni� bps OF <br /> T <br /> bp <br /> r <br /> I W qrao�e. <br /> -LIDoc) ao 1 C3I`I Ids a r 0 <br /> rou n-A <br /> V" <br /> Z <br /> o In ni w DaO 'V <br /> —�� aN m <br /> m m <br /> CONDITIONS OF PERMIT: '0 m y.: N 0 5' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. UOE <br /> cn G) 2 i m <br /> 0 : aff 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 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- vs 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. I <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 n p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m : m <br /> CD v I <br /> CD c m <br /> SIGN HERE <br /> (signatI1,0110 <br /> oxmer or building contractor) (date) <br /> ZONING ADMINISTRATOR 'Ayr,yr, r fan.Y'/E- g <br /> fn <br /> N N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o �, �, �, g m <br /> 000 $00 $$ m fn <br />