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el <br /> Burns" County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o' o 0 <br /> APPLICATION FOR - LAND USE - PERMITS _ >E <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q m ° <br /> located as shown IlerNrryy,n. The undersigned agrees that all work shall be done in accordance with the requirements of the m c `�V <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the'laws and $ w <br /> regulations of the stale Of Wisconsin. <br /> T�- // // II 1 // w m_ <br /> OWNER TELEPHONE o m O <br /> TELEPHONE n f <br /> � <br /> ADDRESd`7 (,-7 ( (/I.LOS.PI <br /> EMERGENCY/FIRE NUMBER a-7 6--7 If ROAD NAME oar rp ( Sq <br /> LEGAL DESCRIPTION (see tax receipt) r I F-C� 5 <br /> SE � �E� S- 2-q( 40 I SW <br /> CONTRACTOR L <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o ,� <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONa o <br /> _ <br /> ^ 0 T <br /> STRUCTURE/ADDITION USE: g <br /> S � <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 23 <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) o W <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). �J <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 1A <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 sl' and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEISSUED. 3 N <br /> PLOT PLAN o n <br /> s A <br /> � m <br /> G o <br /> C w <br /> I <br /> C m <br /> o <br /> OQ _ <br /> o I _ <br /> II.p <br /> _ <br /> m - <br /> o � <br /> w <br /> 0 <br /> z <br /> I i <br /> r <br /> M soLn-V Ln r-DDF m <br /> CONDITIONS OF PERMIT: v' g c S M <br /> 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. G i `� -{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` :N: ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L'' E m <br /> Al: ggE . <br /> `eclaro That this application(including any accompanying schedule)has been examined by me and to the best of my knowl• <br /> to and belief it is true,Correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- QS, E B p <br /> on I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to iaaue <br /> Ir accept all liability which may be a result of the County of Burnett relying on this information I am providing itt thin ae- <br /> on.I agree to Pefmit County officials charged with administering county ordinances or other authorized person to have ` <br /> to the above described premises at any reasonable time for the purpose of inspection. 9 <br /> o: <br /> m i O i o f <br /> m 3 <br /> VIE <br /> (signature of owner or buil(An ontr tort (date) E «« <br /> MSINISTRATOR <br /> 488 <br /> ffiTOWNSHIP P MY BE REQUIRED m <br /> H�N 8999 vi <br />