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1�C�vyl <br /> Burnett Chanty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to m -0 o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> 0 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <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 County Ordinances and the laws and <br /> regulations of the State of Wisconsin. Tom/ <br /> ��` G <br /> OWNER TELEPHONE �9 y�y V' fE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER �3 c/ ROAD NAME '31 <br /> 6 1 <br /> LEGAL DESCRIPTION (see tax receipt) $c .�,f 7-3C,/ 'P/4 N/ Fi-, X/v SLrJ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION T v <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING -U,NIIT\ SUBDIVISION o <br /> STRUCTUREIADDITION USE: t<ft*1 .., , Cu 4'-V1IU (7 J) T 0 » <br /> (Home/Cabin; mmercial Business;Bedroom; Deck; <br /> etc.) Z <br /> 0 ° <br /> a <br /> } <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 drainf laid (DF). o <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 Sig�led and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A a m <br /> PLOT PLANP o <br /> (� oEL <br /> o <br /> C <br /> s (O <br /> ,l o <br /> J <br /> 1 (� <br /> 0 <br /> J <br /> o o <br /> � fr <br /> 110 <br /> KL�� 'J'�wN ldU � <br /> ��jY��jfY.• 131�� K �. f <br /> RS T'T r p f y <br /> � _ , o m <br /> g yg� �0-N m 9 <br /> CONDITIONS OF PERMIT: < W ; Q ffi g S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a �`z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - = 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �1 i `• 39 Ni 0 <br /> QQ f L C <br /> 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of My knowl- o : i � <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- E «m «; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 4�permit. 1 $'s 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- I <br /> . <br /> plication.I agree rinit county officials charged with administering county ordinances or other authorized person to have p; <br /> access to the ve escnbed premises at any reasonable time for the purpose of Inspection. e <br /> ID <br /> SIGN HERE �L <br /> (signature of ownsDull Inge n c (date) <br /> MAI <br /> i <br /> ZONING ADMINISTRATOR g ' '• <br /> TOWNSHIP IPERMITS MAY BE REQUIRED N in m <br />