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ON COMPUTE WSCANNED EVI 60T n <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w M o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and �2 y <br /> 0 <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 a <br /> regulations of the State of Wisconsin. -- o <br /> y w <br /> C <br /> C <br /> OWNER Ke �w►�r>�San� TELEPHONE <br /> ADDRESS m <br /> of �' <br /> EMERGENCY/FIRE NUMBER ROAD NAM TJ \ <br /> LEGAL DESCRIPTION (see tax receipt) `� 5c YL S LJ rt/ , <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION_ p <br /> s7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: C I7 a%.=NGi-C� �' 17 I� o g <br /> (Home/Cabin;Commercial Business; Bed m;Deck;etc.) Z <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). <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 7 Cn <br /> PLOT PLAN Z <br /> !! U1 ym <br /> See- Pff�Jed Pf6� P/ate c 1 <br /> M Z <br /> 0 <br /> S <br /> 1 <br /> Cn <br /> CD <br /> N <br /> O <br /> 7 <br /> 7 <br /> N <br /> Z <br /> T. Q a mN r. 3) <br /> CONDITIONS OF PERMIT: .0 � y.: Z H 8 C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c T33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. vt : 32 m <br /> 0 ; a� <br /> declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m m C <br /> rdge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa i E"w A m <br /> ion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o p <br /> cation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o`$ o <br /> urther accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> lication. I agree to permit county officials charged with administering county ordinances or other authorized person to have 0 0 <br /> ccess to the above described premises at any reasonable time for the purpose of inspection. <br /> -n <br /> v <br /> m <br /> / N N 00 i <br /> IGN HERE d, <br /> (signs of caner pf building contractor) ( (date) ; <br /> 0 : <br /> ONING ADMINISTRA70R • o S <br /> N N W N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED � � . m <br /> � � O m <br /> 000000oom <br /> 000000000 <br />