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0a (am* <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The i indersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordir ance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisc 3nsin. N m <br /> N � <br /> OWNER 1:)4 ) I LQ A 6 TELEPHONE <br /> ADDRESS N r'M' ^Og�:'K e�I Z -^ tl �/a'L- l:CrnJ I vz' -7-1t) 6 . <br /> EMERGENCY/FIRE NUMBER 13 .:� O ROAD NAME <br /> LEGAL DESCRIPTION (see tax re eipt) �4-f� 2�►� 1: -j&/ L QQ P �L <br /> CONTRACTOR S L <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION X <br /> L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° <br /> _ <br /> _ I_ m � <br /> STRUCTURE/ADDITION USE: L' 1 V I Al � 356°�bW�/ OP� o <br /> (Home/Cabin;Commercial Business; Bad oom; Deck; etc.) Z a <br /> 0 a <br /> N <br /> 3 <br /> DIRECTIONS FOR PLOT PLA N DRAWING: (Aerial or top view) Q <br /> 1. Show the location and si 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). I o <br /> 3. Show dimensions infeet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building - <br /> measurement to the ordini ry high water mark of lake,stream, or river. Q (� <br /> 4. If separate plans are subm tied by an architect,engineer,builder,contractor,etc.,the plans must be signed <br /> dated by the owner. 3 rIj <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a to <br /> Mill C <br /> PLOT PLAN < a 'a <br /> `tel S e S of I M o <br /> t = <br /> q �0� <br /> 320 111 <br /> 3e' Baa ig�� <br /> 9l(o <br /> N <br /> _ <br /> 0- Sei-�S m <br /> p <br /> � z <br /> -------------- <br /> f <br /> �c <br /> �1tJ7 �Jb3M c �0g0afITI <br /> v <br /> m-. 9 E � 2.a y C = W <br /> CONDITIONS OF PERMIT: ^ < S.: ,Z '$ rp T+_ <br /> 1. DRIVEWAY MUST MEET RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <br /> 2. REMOVAL OR CUTTING DF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. __y i 17 <br /> r' ' M ; i O <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. W� 'No g p <br /> I declare that this application iincluding any accompanying schedule)has been examined by me and to the best of my knowl- g : <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- d'w T <br /> tion contained in this applicat on(including any accompanying schedule)and I further declare that I recognize that this infor- i p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. if o' � <br /> further accept all liability whic 1 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 coi my officials charged with administering county ordinances or other authorized person to have E i O a o � <br /> access to the abov escriD mises at any asonable time for the purpose of inspection. m ; 3 bb o <br /> SIGN HERE [/`/ <br /> is u of owner or buil g contractor) (date) <br /> P : x <br /> ZONING ADMINISTRATOR MAY ' 8 . x E <br /> X T <br /> TOWNSHIP PERMITS MAY BE REQUIRED it.- - --- 'o � .uNi � m <br /> oo < <br /> film m <br /> 0 <br />