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1fl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator cn v I Z <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 w = J <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m o <br /> Burnett County Land Use Ordinance,Sanitation Cotle, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> o <br /> OWNER <br /> 1�a, if - 1 o - t) TELEPHONEn O <br /> 3 -7 - '2 > <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER <br /> G! �Y - ROAD NAME ` <br /> YGG�C m �r. cit= <br /> LEGAL DESCRIPTION (see tax receipt) , . I <br /> 3 " - /Y a/ PCL 4vE Sc <br /> CONTRACTOR ,2 I !' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X' ADDITION <br /> o (� <br /> SANITARY PgIW FILLING/GRADING <br /> CAMPING UNIT SUBDIVISION - o <br /> 0 <br /> STRUCTURE/ADDITION USE: La nyIaC - <br /> r <br /> o <br /> (Homd/ abin;Commercial Business;Bedroom; Deck; etc.) <br /> m <br /> z <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or tap view) I � <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). <br /> measurement to the ordinary high water mark of lake, stream, or river. <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 /> 71 <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMITCAN BE ISSUED. C o <br /> PLOT PLAN o m <br /> �I Z <br /> C <br /> Cali _ <br /> .2' <br /> J O <br /> c i <br /> 1 o <br /> a � <br /> k <br /> C + Z <br /> r <br /> _ w <br /> xbnrnm�nrnn <br /> CONDITIONS OF PERMIo � <br /> c �. a <br /> T 2 a mc a m m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. C m o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p m n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N a N- m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g m C <br /> edge and belies it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy t all informs- .� <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- p1 «' m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin rt determining whether to issue a permit. 1 ? o a o C <br /> further accept all liability which may be a result a the County of Burnett relying on this information I am providing In this ap- o o <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. H <br /> m <br /> C T [ 3 $ <br /> / 0 ^ N <br /> SIGN HERE <br /> (signature o owor or building contractor) (date) d' .8 <br /> ZONING ADMINISTRATOR �1r3f1J/x1.. <br /> o : <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> NN (.rNNN <br /> N m V m <br /> O N n i N N N p <br /> 00000 ' 00 m <br /> 00000 $ ooM <br />