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D% comp; <br /> dumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator in m' o c <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m <br /> Ig by application for a Permit for the work described and � a � �/ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m U} <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and thelaws and J� <br /> regulations of the State of Wisconsin. ir <br /> m <br /> / C �? <br /> OWNER e- � I/ Y i 1 (- TELEPHONE � /_ Qy, o �0 <br /> 1 tL o m <br /> ADDRESS 12'7 r n05,5208 ' <br /> EMERGENCY/FIRE NUMBER ROAD NAME`^1 y. . '^„f a <br /> 'v 1 OWRi r Qr \ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR C awn <br /> ti <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: ' 0- <br /> o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o 0i <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 Nor h (N). ^1 <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 I 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 sl 3ned and 0 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. C 0 v N <br /> PLOT PLAN o g <br /> y�liSC iA <br /> C c <br /> M <br /> �i <br /> 0 <br /> 0 <br /> i <br />*OLO+t ne <br /> 2)d"raroad <br /> 3� <br /> 09WA4 0� rf Ye r : 9/0' <br /> CONDITIONS OF PERMIT: c m m <br /> ZCrB g� '_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER IT I LANCE. Z m b'`. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I. r^ : t7 T <br /> J $ : <br /> 000p i O <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 a I informa- «mer m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- I/J <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n Chia ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pare n to have <br /> access to the above described promises at any reasonable time for the Purpose of inspection. 0 O: <br /> ' <br /> m <br /> ' m <br /> 'w <br /> SIGN HERE <br /> (signatu of wrier or u q contractor) - ' a <br /> ZONING ADMINISTRATOR11-1 t <br /> OWNSNIP PERMITS MAY BE REQUIRED MAY I `S'N`” '"H T <br /> oviSu 35m <br /> 88888 ai <br />