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Cay( Garr1�0, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. M <br /> m O <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and �2 y <br /> located as shown herein. The ui idersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordini nce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wiscc nsin. <br /> N � <br /> C <br /> /� - gqo 3 g� (/ a O <br /> OWNER UQ u N L Lt TELEPHONE o <br /> ADDRESS S /-� - 13 Y <br /> EMERGENCY/FIRE NUMBER Cf YC c ROAD AME �g30 <br /> LEGAL DESCRIPTION (see tax receipt) r L _ ._ Q <br /> CONTRACTOR - <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION j °. S <br /> STRUCTURE/ADDITION USE: B QGk WC 1'f 1Ql" �` C2/7 c /n E <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> o <br /> m <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 thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinaiy 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 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> PLOT PLAN � / _L m o n <br /> See v / y <br /> a <br /> ® � c l <br /> ( 0) <br /> 6 <br /> N I^ <br /> O UC` <br /> O � <br /> N <br /> Z <br /> C <br /> bn r�lvr�r D Dom <br /> f <br /> m 33 i£� a a m a$ y <br /> CONDITIONS OF PERMIT: ^ Z': Z C6 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> H: �: <br /> 3, NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ,,`` c iij O <br /> I declare that this application(i icluding any accompanying schedule)has been examined by me and to the best ofmy knowl- <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- i i «�m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,8 B - p <br /> motion I am providing will be ielied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability whict 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 hav O p <br /> access to the above described premises at any reasonableltime for the purpose of inspection. <br /> m 3 <br /> �} <br /> S - 3 / <br /> SIGN HERE <br /> (si tur of owner i contractor) (date) <br /> o : X <br /> ZONING ADMINISTRATOR <br /> TOWNSNIP PERMITS MAY BE REQUIRED o N N <br /> / uO utmN <br /> 000 m <br /> oob o m <br /> o U) <br /> w <br /> 0 <br />