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Burnett County 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Administrator <br /> I. m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 0 <br /> Z2 <br /> c <br /> located as shown herein. The L ndersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin, <br /> N d ) <br /> w � <br /> c <br /> OWNER O V (, cA /�-F5c-1 TELEPHONE 7I�-._ 635 - 9331 '� <br /> ADDRESS V r/�! �TS L� �� -_ —�i/„�//�� m4 Lt 1 _ <br /> EMERGENCY/FIRE NUMBER / (� ROADNAME 13c of 7-rRAO- <br /> LEGAL <br /> LEGAL DESCRIPTION (see tazre ipt) •L V O P 260 <br /> CONTRACTOR c GL yO/q J, 1400 V 400 /SGL GoU r—OTLOT 13 11) <br /> TYPE OF PERMIT(S):`DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE_� ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° --), <br /> STRUCTURE/ADDITION USE: I ' 0 <br /> (Home/Ca ;Commercial Busi ess; Bedroom; Deck;etc.) Z m <br /> 0 ° <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLA14 DRAWING: (Aerial or top view) <br /> 1. Show the location and six of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the vy ell (W),septic tank (ST), and drainfield (DF). 0 <br /> 3. Show dimensions in feet of he following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordina high water mark of lake, stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o N <br /> c <br /> PLOT PLAN o n <br /> --- Al fit <br /> /oo 4co S <br /> uJ <br /> ,� <br /> m <br /> �— Av�a�x 3�y% <br /> N <br /> [7 f ° <br /> �— o <br /> y <br /> / UQ <br /> _ /t/0 (ueIAlc� to <br /> iso ' <br /> 9a � tv _ <br /> ygy <br /> 33 F <br /> d <br /> ff g•F.m 33 <br /> CONDITIONS OF PERMIT: o N.; Q C6 g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m ; ? V2 -� <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> N [ uj2o� m <br /> $ E a 2 E ' O <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- 0: 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- a y m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 cour ty officials charged with administering county ordinances or other authorized person to have N o' <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE 2 8 <br /> n tura of o or Duildfng contractor) (date) <br /> ZONING ADMINISTRATOR i $ i <br /> 8. x . <br /> TOWNSHI PERMITS MAY BE REQUIRED x o N m <br /> $ $ $ $ Th <br /> w <br /> 0 <br /> 1 <br />