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� cep. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o a <br /> APPLICATION FOR — LAND USE — PERMITS d 3. o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. N m <br /> —rho <br /> / m O <br /> OWNER - ! ho ,"as d Dyke TELEPHONE —"$_ X56- 3(oz6 p 14 <br /> /' 0 <br /> ADDRESS P Q GO X u /I .fin 1 b(�4WZ 5'1D'30 <br /> EMERGENCY/FIRE NUMBER + I ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) ICI �(/d _ / <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> I �/ <br /> STRUCTURE/ADDITION USE: I V 'I I �DO �U IsCox <br /> (Home/Cabin;Comm4rcial Business; Bedroom; Deck;etc.) z S <br /> 0 0 o r <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 3 <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11111 a m <br /> PLOT PLAN k ' 1 / pZ <br /> 0 <br /> m <br /> 4 <br /> I � � ly Weil <br /> 50 7 0 <br /> 0 <br /> N <br /> 50+ <br /> A � <br /> V <br /> 1 » <br /> 6 No-r Z <br /> o un <br /> 31 <br /> I F <br /> Mafm <br /> m <br /> CONDITIONS OF PERMIT: ^ < _': ,2 C 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 T'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a' : 3 o � O <br /> _PZSs 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.1 acknowledge that I am responsible for the detail and accuracy of all informa- «r m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- - B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 3 <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- N <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ,,, 0: <br /> access to the above described Premises at any reasonable time for the purpose of inspection. m 3 0 R <br /> m b App N <br /> SIGN HERE <br /> (sig u oto er or b 'Iding contractor) (date) - o <br /> ZONING ADMINISTRATORz <br /> TOWNSHIP PERMITS MAY BE REOUIREOo � � 0, o'006 <br /> N m <br /> $ $ $ , 00u) <br />