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69 9 40yy, <br /> Bufhett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 1 m 0 0 <br /> APPLICATION r=OR - LAND USE - PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 N <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 1 11 <br /> regulations of the State of Wisconsin. <br /> c <br /> c <br /> OWNER L1 TELEPHONE o. <br /> /T� /y� <br /> ADDRESS �/ /FI;7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (seetazreceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_� ADDITION p <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> I N 0 <br /> STRUCTURE/ADDITION USE: /� Sfrowt*-6 � C'M o 0 <br /> (Home/Cabin;Commercial usiness; Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a _ <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 (D17. <br /> 3. Show dimensions in feet of the following:(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 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIF TION BEFORE A PERMIT CAN BE ISSUED. 11 3 to <br /> PLOT PLAN Z <br /> A � a <br /> -� -� M �7q- <br /> ,60 M <br /> r�we' <br /> z <br /> C> C71 <br /> 1 � <br /> v73 ROf} CMS 0a * M <br /> 02. .0 12 <br /> 2. p K,� : 6 <br /> CONDITIONS OF PERMIT: y': Z 8 gr'p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ O : �4 <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. !" i c 2 i-++: m <br /> O <br /> a: <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m _ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inlor a p <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 <br /> access to the aboveesC7ib5dpremise3 ata able tim for the purpose of inspection. . 3 g <br /> T <br /> SIGN HERE <br /> si s u e of owns r ui I convactoq - {dela) I I v 7 <br /> ZONING ADMINISTRATOR "" • [ N x ? i <br /> TOWNSHIP PERMITS MAY BE REOUIR N�c n?S m <br />