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dig, c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (e m c a <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m o � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'Z m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. y m <br /> O <br /> OWNER ICL� I�r e TELEPHONE o <br /> I 1 JJJJ T�, F <br /> ADDRESS a g C157 / v er 4 j 4JIT'_`3l.cr, Cdl se/920 <br /> m <rU <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax race pt) <br /> CONTRACTOR Se <br /> TYPE OF PERMIT(S). DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> n L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° <br /> 3 T <br /> �� JJ w r ) <br /> STRUCTURE/ADDITION USE: c Ctt/'UJ f-�AnGI ° <br /> v R <br /> CD <br /> Home/Cabin;Commercial Busi ass; Bedroom; Deck;etc.) Z o �" <br /> o 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 Ill te following:(a)building to all lot lines,(b)building to center line of road,(c)building 14 <br /> measurement to the ordinarf high water mark of lake, stream, or river. 0 <br /> 4. If separate plans are submi ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE. BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in m <br /> 11 Z Q <br /> PLOT PLAN � ( cc) y a <br /> o <br /> C ' <br /> MI <br /> n s <br /> Sv � <br /> 9J C s <br /> C, <br /> 00 <br /> d � 0 <br /> 0 <br /> o � <br /> _ z <br /> F <br /> O c-a m r o a 0 -0 <br /> m $� 2. e m y <br /> D m <br /> CONDITIONS OF PERMIT: ^ < m' PC$ .0 Q5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 5 fir ' � <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = )'-ew: M <br /> 3. NO GRADING OR SHORE B <br /> ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - r" O Off �o m <br /> : C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: g-a) <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «�y w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a <br /> plication.I agree to permit cour ty officials charged with administering county ordinances or other authorized person to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T V O Jc :tq <br /> m b tN <br /> SIGN HER <br /> (signature of owner or building co rector) (date) <br /> 20NING ADMINISTRATOR a C� x <br /> (� x x x <br /> 1a�H Hx xyx,.m <br /> TOWNSHIP PERMITS MAY BE REOUIRED q o N N <br /> O000 $ g29911l <br /> as <br /> 0 <br />