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Burnett County 7410 Co. Rd. K, No. 102, Siren, 111 54872 Office of Zoning Administrator �m l : o o! <br /> APPLICATION FOR — LAND USE — PERMITS £ <br /> TO THE ZONING ADMINISTRATOR:Thedescribed - ° <br /> undersigned hereby makes application for a Permit for the work and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremenitof the $ r <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the 18ws andregulations of the State of Wisconsin. m <br /> OWNER A/r TELEPHONE _ 4 <br /> //'�012� a £ <br /> ADDRESS 6U4. <br /> EMERGENCY/FIRE NUMBER3 Q AD NAME 3 t� <br /> ti <br /> LEGAL DESCRIPTION (see tax receipt) _62 <br /> /� (T1 <br /> CONTRACTOR S �- Z 'ee r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGElACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° (D <br /> J <br /> G,a ,�vr 0 <br /> STRUCTURE/ADDITION USE: o ° <br /> e_/C in;Commercial Business;Bedroom;Deck;etc.) IT Z v <br /> o ° <br /> 0 <br /> m <br /> 3 <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 (yi),septic tank (ST), and drainfield (DF). 5 <br /> 3. Show dimensions In feet ofthefollowing:(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. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 y <br /> c <br /> PLOT PLAN Z y. <br /> �J N <br /> VV11VV// O <br /> III <br /> C <br /> Pole aIJ Af-'See S <br /> C) J <br /> 0 plot `moi 0 /0 30 ' j <br /> p <br /> 1 If z <br /> L) lc rfv� <br /> g m <br /> µA auer�3oo m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. � G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r2 E i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> i Lr [ C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> 4L�. . <br /> edgeand belief it Is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- j iN m N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that Ihis infor- . ` B `,a ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit._I i 8'8 8 <br /> further accept all liability which maybe 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 panic n to have i 0i pi <br /> access to the abovescribed premises at any reasonable time for the purpose of inspection. m '• <br /> m <br /> SKIN HERE . <br /> N: <br /> (sign u of owrii r Iding contractor) (date) i <br /> ZONING ADMINISTRATOR 8 <br /> NNN+�NMNN+ T <br /> TOWNSHIP PE ITS MAY BE REQUIRED m <br /> 888888'88 U)) <br />