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col Cal/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator in -a - c <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. H m <br /> G m <br /> C <br /> OWNER/ ,I ()g4,4,,'5Se TELEPHONE ago K ' £ <br /> ADDRESS Vo^-� m <br /> S 1 <br /> EMERGENCY/FIRE NUMBER �1 G'Gl 83 ROAD NAME `F-Lt— <br /> ^�, <br /> LEGAL DESCRIPTION (see tax receipt) —`41 i2t VV L-0Tft 5 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION >11 p (D <br /> C) <br /> SANITARY <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> H <br /> STRUCTURE/ADDITION USE: PyFTFF o 0 <br /> v n <br /> (Home/Cabin; ommercial Business; Bedroom;Deck;etc.) z o <br /> o c <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 (N),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,( )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 X <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o u, <br /> PLOT PLAN z c <br /> o n <br /> I` 5 <br /> M kwN N <br /> f a I <br /> 1 <br /> V <br /> P Via' <br /> , �{ e'L' 0. <br /> L, � W <br /> ' S . weJJ�O A '�k. Z Cr <br /> CAIBta ay � m � <br /> 12 Po 75' <br /> o <br /> z <br /> 1 � <br /> n5 �/ <br /> I <br /> Ml;�erzxnfc.Ola,�E � <br /> tar LojLoct+ I�Sr 0 nS42.aa 9, <br /> CONDITIONS OF PERMIT: v 2.: c g 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 m o Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p ` ` N 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. G <br /> :' Si iE ` S C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- •+m w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inforB 8 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <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- i i i i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to havep <br /> access to the above d scribed premises at any reasonable time for the purpose of inspection. 0' <br /> In <br /> SIGN HERE <br /> Igna to f own uilding contractor) <br /> ZONING ADMINISTRATOR ' -' I : 8i <br /> IWV 41, <br /> TOWNSHIP PERMITS MAY BE REQUIRED -I <br /> !I j S g ti N i�g m <br /> 88888888tH <br />