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Burnett County 7410 Co. Rd. K, No. 102. Siren, W1 "872 Office of Zoning Administrator (a m [ c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 v <br /> located as shown herein. The uridersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the Stale of Wisconsin. m <br /> c o <br /> O <br /> OWNER ` TELEPHONE <br /> 1e <br /> avl) Ter©pte- 65-6- ,4o,;2 i m C <br /> ADDRESS 304 / // 'n1 <br /> lour ICq Ce i`..� <br /> 00 <br /> EMERGENCY/FIRE NUMBER 30 367 /4- <br /> LEGAL DESCRIPTION (see tsx receipt) a l t l�l'�i61 <br /> CONTRACTOR G/ey S G /Act <br /> TYPE OF PERMIT(S): DWELLING/BUILDING- GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> o c J <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z o <br /> o v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top 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). 4 <br /> 3. Show dimensions In feet ofthe 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 v <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. v N <br /> Z a <br /> PLOT PLAN � � A o <br /> w <br /> aS <br /> M <br /> N <br /> 1 to <br /> o <br /> 0 <br /> O <br /> xa <br /> O n y <br /> =rj R1IZ <br /> m <br /> M <br /> CONDITIONS OF PERMIT: o' g z•: M <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o' Z ; -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P E ` i c m <br /> XI <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> Lr E C <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 8 ? m <br /> tion contained in this application(Including any accompanying schedule)and 1 further declare that I recognize that this infor- p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue ■ permit. 1 81 $ <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 tonnit county officials charged with administering county ordinances or other authorized person to have <br /> access to the&Va diescribed promises at any reasonable time for the purpose of Inspection. T <br /> @ : ! <br /> SIGN HERE �1� <br /> Innd N i <br /> (sign of owner or building contractor) --(date) - !; 3>t E <br /> ZONING ADMINISTRATOR "" ` '. 8 i <br /> TOWNSHIP PERMITS MAY BE REOUIREI J Qo 1 k'J�'+l m <br /> r,n <br />