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4.JIv c..vlvlru I �rv�Vf-�,Ivlvrt.a (�'l (�{17l l�i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 64872 Office of Zoning Administrator ( m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 3 d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m C <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. � <br /> w <br /> �Jn O <br /> OWNER 1 1' -� �.�% _ TELEPHONElLl L 4 a f <br /> I t✓ v ' <br /> ADDRESS vit '0 Z— A S. m Y� _..s-1 <br /> EMERGENCY/FIRE NUMBER /�/r1 A t ROAD NAME /flat(�f/4 Q� <br /> /f�' VJ4�C JI / r•' y /" � <br /> LEGAL DESCRIPTION (see tax receipt) /aV yZ ) n/x& <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 0 o <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: ��iw I F>N <br /> (Home/Cabin;Commercial Business; Bedroom Deck;etc.) Z o <br /> o 0 <br /> �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 drainfield (DF). 0 <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 /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'w N <br /> all! Z Q <br /> PLOT PLAN <br /> n o n <br /> N <br /> N i � <br /> 7 <br /> oT <br /> 7- V �oaD-oi ADO <br /> A <br /> tAl N W <br /> o <br /> m <br /> v � <br /> !/1 <br /> C' Jam''v <br /> Z <br /> CONDITIONS OF PERMIT: <.y' �' g 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' = m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ro !: C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. N w�+► XI <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m id m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $� $ <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 <br /> access to the described pre ises at any reasonable time for the purpose of inspection. <br /> _ -n <br /> SIGN HERE <br /> � N <br /> (sign re f owner Iding contractor) <br /> ZONING ADMINISTRATOR <br /> N <br /> N-�N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED JUL 2 2 1994 o cNn is P cP <br /> �`, 8 $, g�$ $ 8 <br />