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cyt C"P;-4 , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator tw .0 v Z <br /> APPLICATION FOR — LAND USE — PERMITS 3 P <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w ° 25 <br /> — <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremerts of the m e <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I iws and <br /> regulations of the State of Wisconsin. <br /> OWNERO a E� 7 /" L TELEPHONE _ (I <br /> o = <br /> ADDRESS 01 �= <br /> !JcC/Z 2 o �_' YNME'�6�W6', <br /> 5 = r <br /> EMERGENCY/FIRE NUMBER 70 ROADn — q 7— <br /> LEGAL DESCRIPTION (see tax receipt) ` ` 4"J _ <br /> CONTRACTOR OILi./ <br /> �s C ��s-ass-ate <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo <br /> o` 11 <br /> STRUCTURE/ADDITION USE: 2 <br /> /� o <br /> (Home/Cabin;Co 0 ercial Business;Bedroom;Deck;etc.) v <br /> Z o <br /> O 9 <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). 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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEUED. 111 a <br /> -{ - 4 <br /> PLOT PLAN Alc4L) /r/Ornr �rbjL/ 19? <br /> 751 <br /> O <br /> �i <br /> N I - <br /> O ' <br /> /6 = <br /> ti <br /> Z <br /> 6 ------_ n)W�^ <br /> e�L b Iowvn -RZ'iR EL <br /> ��DnF m <br /> CONDITIONS OF PERMIT: o. r� °'§ Q,_. >7 <br /> < rv: Q X N <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m i5': Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a = �N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. uai - m <br /> I declare that this application(including anyaccompanyingschedule has been examined by me and to the best of my knowl- o E ` C <br /> apP ( g 1 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(Including any accompanying schedule)and 1 further declare that I recognize that thi infor- )' `J f ti B ,�' m <br /> motion 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 hisap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person o ha ` <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 'n <br /> Q m e <br /> SIGN HERE <br /> (signature of owner or building contractor) (eats) ' f° <br /> o : <br /> ZONING ADMINISTRATOR Drn A DInI 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED `e N�~��N y T <br /> M- <br /> 9 <br /> 088888 $8 ami <br />