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Alt �011 <br /> Burnett County 7410'Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d o <br /> TO THE 7.0NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � c (� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m + <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> w <br /> C <br /> m O <br /> OWNER Jo^n mife'f TELEPHONE (715) o �� <br /> ADDRESS Sox 319 Siren, WI 54872 <br /> L \ <br /> 3S <br /> EMERGENCY/FIRE NUMBER ROAD NAME SFate Highway <br /> ) <br /> LEGAL DESCRIPTION (see tax racer Lot 1 , CSM Vo.t'. 1 , Pg. 290, Section 20, T39N, R16W, Y- � <br /> CONTRACTOR Town of Meeno:a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o 0 <br /> SANITARY__ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° <br /> r <br /> STRUCTURE/ADDITION USE: SC.nitaAy Only o <br /> (Home/Cabin;Commercial Business: Bedroom;Deck;etc.) = v <br /> o ° <br /> n ` D <br /> N � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) J ` <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). I <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -4. <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 M <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSME VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In 3 v, <br /> C <br /> PLOT PLAN o a r \ <br /> III dJ 0 <br /> M tU <br /> III <br /> I <br /> 1 <br /> SES ATTACHED <br /> 0 <br /> 0 v 1 <br /> O <br /> m <br /> O <br /> I <br /> 73 <br /> Z <br /> CV <br /> G <br /> m e y m n a 0 <br /> m 00 M <br /> m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _N <br /> N; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o : m <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 n: In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 1: �" is o : G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o(8 o <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.1 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 reasonable time for the purpose of inspection. 3 g <br /> AA N <br /> N w p <br /> SIGN MEREmi <br /> ()cde R l,h!^c 7112193 <br /> INIS �(s�gpatur of ownder r ilding contractor) (date) <br /> ZONING ADM <br /> NOV <br /> 'n <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N a N m <br /> i.. ... 0 6 0 o y <br />