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a) cbl-�10 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m `0 <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. y m r <br /> w � <br /> c <br /> OWNER '/ Q ' I TELEPHONE Pf z- 5 S S-'4 l 5 <br /> � h 3 a <br /> rl% j7l t1& ( )`�, C7 a N0. <br /> ` L A <br /> ADDRESS I cl -2O yl S*T du 0 +11y 1 tD <br /> 1 l <br /> EMERGENCY/FIRE NUMBERj S 3 / ROAD NAME Q 1 <br /> i ) t56 o OL I <br /> LEGAL DESCRIPTION (see tax receipt) `lg, L. 5 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> r <br /> C <br /> STRUCTURE/ADDITION USE: orNG <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> m I <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 infeet ofthefollowing:(a)building to all lot lines,(b)buildingto 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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an3 to <br /> PLOT PLAN 0 <br /> o n <br /> fn o <br /> N <br /> -5 <br /> I N <br /> n <br /> 0 <br /> 0 <br /> 0 {nn t <br /> 0 V 1 <br /> er <br /> � I <br /> O y <br /> y <br /> -• Iv <br /> 2 <br /> N <br /> ( <br /> �a� '�Zm�T Ia01 <br /> D (1� r� <br /> O_c d o M MM <br /> m $� 9 = MM <br /> CONDITIONS OF PERMIT: v m CS .0 C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P � : - �-,—N: M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> 0 . <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 I further declare that 1 recognize that this infor- ? `� B : m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0i <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 N <br /> access to the above cribed premia at any reasonable time for the purpose of inspection. 3 b nmn <br /> N 9 ^O 0 <br /> (D : <br /> SIGN HERE .X=!" `� �S -3 - <br /> (sign f owner ilding convector) (date) N � <br /> o s: <br /> ZONING ADMINISTRATOR S <br /> NNN�NNNN �I <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 8i u"i N 0 m m <br /> 000000 0 o f/1 <br />