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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 1 0 <br /> APPLICATION FOR — LAND USE — PERMITS _ f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. "' o <br /> w w <br /> w � <br /> OWNER v TELEPHONE a <br /> 7 <br /> d O p <br /> ^^ADDRESS :57 <br /> �-Lhrnedi1J / pj �5w� <br /> OQ <br /> EMERGENCY/FIRE NUMBER ROAD NAME Plot 's,^� <br /> LEGAL DESCRIPTION (see tax receipt . ( <br /> CONTRACTOR j)' <br /> TYPE OF PERMIT(S): DWELT LING/BUILDING GARAGE/ACCESSORY STRUCTURE L ADDITION p �` <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> 3 <br /> ��rt o <br /> �/ JCA/\ w r <br /> STRUCTURE/ADDITION USE: 3 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <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 drainfieid (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. 0 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a rn <br /> PLOT PLAN 0 Z <br /> V <br /> �, PvOr <br /> L� oc� �I m P S t <br /> 9 > <br /> a <br /> (A <br /> /cJ �'oJ �\ mUJI <br /> 'A m <br /> N <br /> u. U <br /> v, <br /> o � <br /> IV <br /> z <br /> / rcolikolU/,A) <br /> 1 ^ �D+ � N V tllr ➢ Dp <br /> CONDITIONS OF PERMIT: Jt/Cim <br /> ! J A' /.. �A` l AeVol,r/, ? a F� m c am' 3 FB' <br /> 7a �l <_. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. r o F i ? T� o 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - »r m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> g off : <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g m ° m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- w m`n 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g 8 <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any Wasonable time for the purpose of inspection. m 8 R <br /> ° V A w <br /> SIGN HERE <br /> (signature o ner orb m ntractod C=' (dasep o : x <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REOUIRED I ), N N "�a " <br /> AUG 261992 NNON Om <br /> 8888 $ 8O9w <br /> i�f <br />