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XLA <br /> cwt ceotf, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator m o 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS f <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes 3 ° <br /> 9 by application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement 3 of the m <br /> BUmett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the Is Ns and $ I <br /> regulations of the State of Wisconsin, <br /> c o <br /> p <br /> b� xd ` FOWNER <br /> TELEPHONE <br /> ADDRESS /D 7,g12 Ter. i,4A YID/✓e- GCYNS[//``e _ �/.V// J'S�. 0 1 <br /> EMERGENCY/FIRE NUMBER //9d ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE X— ADDITION p <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` _`. <br /> 0 <br /> m <br /> STRUCTURE/ADDITION USE: 0 -� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> J oZ o <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 drainfleld (DF). <br /> 3. Show dimensions in feet of thef011owing:(a)buildingto all lot lines,(b)buildingto center line off 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,bullder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a y <br /> PLO PLAN z cv <br /> Mo o <br /> fA o <br /> N a <br /> 3 <br /> ►) /Ylust �t all GoatkeuAe— 4x, Ul <br /> RcqutKmen3 (See A#(ocrect �fQn Q <br /> 14,ULl (61IRZ5*t O-s ) is Bo 2B' 0j <br /> N <br /> O <br /> J/o"e <br /> � O y <br /> alelk <br /> o <br /> Z <br /> &f m <br /> C NDITIONS OF PERMIT: ; <br /> 1. RIVEWAY MUS DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f �`Z : 1 <br /> 2. EMOVAL CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - N` S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ : O m <br /> I declare that this application(Including anyaccompanying schedule)has been examined by <br /> me and to the best ofmf knowl. o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all nforma• «ro« m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that tt is infor. B p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I `: $'Q $ <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 persor to have <br /> access to the above described remises at an reasonable time for thepurposem : m <br /> D Y of Inspection. <br /> SIGN HERE « <br /> (sig u of owner o ding tor) )' n 1 2 i a' E <br /> ZONING ADMINISTRATOR - 2 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 40 2 ONE <br /> $ 8888888 ai <br />