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�51~r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 5472 Ottia of Zoning Administrator m o 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describ ad and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementof the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the Is Ns and o ro <br /> regulations of the State of Wisconsin. w m <br /> w m <br /> c <br /> OWNER TELEPHONE <br /> L a E <br /> m_ <br /> ADDRESS OGOq LD tDR. VN�)Z , Wj . 5gsg3 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) TI <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 — <br /> '^ r <br /> STRUCTURE/ADDITION.USE: o °— <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <br /> } <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 dralMleld (DF). 01 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)I wilding <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 sigi led and r <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 1A o y <br /> PLOT PLAN Z <br /> p S <br /> • o` <br /> {InAc�}EO o� <br /> I <br /> 0 <br /> oa � <br /> 8 <br /> Iw <br /> O y <br /> w ^� <br /> f <br /> F m <br /> CONDITIONS OF PERMIT: < Z rB g$ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o foi <br /> � i 'i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N ? 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ri,: O m <br /> qq Lr ; O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of i ly knowl- t o E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informa- i N 1, ee : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- <br /> mation 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 this ap- $ i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have ` m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> M `• <br /> SIGN HERE <br /> (signature of owner o ul dl I tort (date) <br /> ZONING ADMINISTRATORI QE <br /> ' NN NN NN+ T <br /> TOWNSHIP PERMITS MAY BE REQUIRED Oo Sa'ffi Sri"'V,8 m <br /> 99 89 $ 0 <br />