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no <br /> Bumftft County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminlat ator rn 'a i z <br /> APPLICATION FOR - LAND USE - PERMITS a2. <br /> f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makesapplication for a Permit for the work describe and Q a <br /> located as shown herein The undersigned agrees that all work shall be done in accordance with the requirements 3f the m �y <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the law s and $ s <br /> regulations of the State of Wisconsin. <br /> m m°_ <br /> OWNER J �,e v 9 Ile C/4 to TELEPHONE 7q� _ 700 � � 1 <br /> ADDRESS <br /> 7-5-0/ %11-top r. / / <br /> /7 , c //S G✓r </ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) �—_ S 7 /✓ QC's'/-rJ �O W d 5 w i f N (/cit `J <br /> CONTRACTOR a" <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION t7 <br /> SANITARY_,_ PRIVYFILLING/GRADING CAPING UNo <br /> o <. <br /> STRUCTURE/ADDITION USE: S N !'IA I'V 0 /L) <br /> (Home/Cabin;Conrlbercial Busines ;Bedroom;Deck;etc.) I M <br /> z a (p <br /> o � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9J < C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North ( ). <br /> 2. Show the location of the well (W),septic tank(ST),and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)but ding Q <br /> measurement to the ordinary high water mark of lake,stream, or river. 0 <br /> lu 11 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signet I and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE LSSU D. ON c <br /> PLOT PLAN A Z v <br /> s P -TTA /, �/ c m <br /> � Q <br /> mw <br /> o <br /> 0 W <br /> O hh <br /> T <br /> d <br /> O � <br /> N <br /> I� <br /> Z <br /> i <br /> QN <br /> C� <br /> O,CM dl 8 DF M <br /> e g4 =-o.e .m m <br /> CONDITIONS OF PERMIT: o' 3 3.; B c u R. 11 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = o'�fi' ? IQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P ' ' y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ren t7 m <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my kwl <br /> C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all info me. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this h for- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a pe ; g'$ 8 <br /> ap- <br /> further accept all liability which may be a result of the County of Burnett relying on this informallon I am providing in thi it. I 1 <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to I laws ` <br /> access to the above described premises at any reasonable time for the purpose of inspection. i <br /> SIGN HERE <br /> (signature of r or uildin ntractor) (date) <br /> o E <br /> ZONING ADMINISTRATOR 9i ; <br /> T NSNIP PERMITS MAY BE REQUIRED �'�'N N N N N y T <br /> ouf5dm <br /> $88 $8888 ai <br />