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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator on <br /> 1 m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m JQ <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. a m <br /> CeneP)=E TELEPHONE = <br /> FOWNERMInC VIDNOAIC <br /> cr <br /> v ' <br /> ADDRESS <br /> c0 I TICI_E81tCI'1 <br /> Vl DR • PIS M - -S yZ� <br /> m <br /> EMERGENCY//FIRE NUMBER �r`� ROAD NAME Ch �CV, 6 , <br /> 111 1 <br /> LEGAL DESCRIPTION (see tax receipt) CKZ <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p [L\ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° O <br /> r <br /> STRUCTURE/ADDITION USE: 8 0 _ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z c `� <br /> O 9 <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 (W),septic tank (ST),and dralnfleld (DF). <br /> 3. Show dimensions in feet of thefoiiowing:(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 signed and A <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on v rn <br /> Z v <br /> PLOT PLAN o <br /> n 's: Ilklc�/1 <br /> M o <br /> P�tt�cKir� <br /> M <br /> 1 � <br /> S <br /> I m <br /> ° <br /> 0 <br /> o <br /> N <br /> D <br /> o. . - ro06 <br /> 33 <br /> CONDITIONS OF PERMIT: R- <br /> 04 Z m o ao ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z i'e'o °`z M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o f T <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I"n [ 47 m0 <br /> PP (including Yaccompanying 1 Y Y g` <br /> I declare that this application Includin any schedule has been examined b me and to the best of m knowl- f m: C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- it <br /> m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. Tim N ? p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g a 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O <br /> access to the above described pnXnises at any reasonable time for the purpose of inspection. <br /> miiiia8woi. <br /> vA . : <br /> SIGN HERE <br /> (si nature of owns u( g c tort <br /> 11 l5 U E s <br /> ZONING ADMINISTRATOR <br /> TOWN HIP PERMITS MAY BE REOUIR APR 2 7 -J3 I 88�b m <br /> 8 888N <br />