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In eaylpt <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describedo and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable Courtly Ordinances and the laws and <br /> regulations of the State of Wisconsin. �, m <br /> w m <br /> ( / n O <br /> OWNER 0 J e^-�' `�'Q TELEPHONE b �2_ SLS 3 zA v <br /> t1 m_ <br /> ADDRESS S I� <br /> 311 IS �uc SO W1+h Yt'1ti YO� m p <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1ft�pSo. A l <br /> LEGAL DESCRIPTION (see tax receipt) (}� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION O, <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: I-(t z <br /> o U <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o v <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 (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)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 sig ed and <br /> dated by the owner. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEUED. 7I 3 rn <br /> 11 Z `a <br /> PLOT PLAN o a <br /> m <br /> O <br /> C l <br /> T <br /> J�---- 9j <br /> N <br /> n <br /> e _ <br /> O <br /> � 391 <br /> i <br /> 1 - <br /> I.- <br /> � Q <br /> " I <br /> 3Y� _ <br /> �`n <br /> - �orZo QQ�K <br /> 32 R � am SDa£ m <br /> $� a�Smith>7 <br /> CONDITIONS OF PERMIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N ` m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of I iy knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al I informs- N N m <br /> lion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that his p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permmit.it. I $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing n this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have o: o; <br /> access to the above jescribed premises t py reasonable time for the purpose of inspection. <br /> m <br /> N : m <br /> SIGN HERE <br /> (date) ? N <br /> (sig u owner or it q contractor) <br /> ZONING ADMINISTRATOR '� <br /> �NN(NmNNN(N(mm T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N N N O m <br /> 998 $988$ w <br />