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V r i V <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m0 OZ <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned 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 <br /> 0 <br /> regulations of the State of Wiscc nsin. m m <br /> N � <br /> C <br /> ^ / d <br /> OWNER <br /> '47*gjAfe IJ �,C TELEPHONE <br /> 0 <br /> p m_ <br /> ADDRESS - GQA /p S/ 4ef? !S c , <br /> EMERGENCY/FIRE NUMBER O / ROAD NAME 'ee. <br /> LEGAL DESCRIPTION (see tax receipt) <br /> rb <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/3UILDING GARAGE/ACCESSORY STRUCTURE�� ADDITION _ o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING _ CAMPING UNIT SUBDIVISION a <br /> o - ` <br /> ' I <br /> STRUCTURE/ADDITIONJ USE: f/V o 0 <br /> (Home/CabV ;Commercial Business;Bedroom; Deck;etc.) Z9 <br /> 0 Icy- <br /> 0 <br /> DIRECTIONS FOR PLOT PLA 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). r <br /> 2. Show the location of thew II (W),septic tank (ST), and dreinfield (DF). g <br /> 3. Show dimensions Infeet ofl he following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinay high water mark of lake, stream, or river. Q <br /> 4. If separate plans are submi led by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O a <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> PLOT PLAN (/ems 11 <br /> z `v <br /> n o a <br /> s <br /> 33 <br /> m � <br /> 1 ~ <br /> Jm <br /> r <br /> 2 <br /> N o m �,: � f0 <br /> CONDITIONS OF PERMIT: C <br /> � c m ,2 $ So� T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY W TH REQUIREMENTS IT IN 60 D S OF ERMIT LANCE. oo Z.'z i -1 <br /> 2. REMOVAL OR CUTTING F TREES A D VEGETATION IS RE R TED AL NG RELI s: M =Nur: >7 <br /> 3. NO GRADING OR SHORE ND ALTE TIONS ARE ALLOWED U ESS S ECIFI AL Y P ED. - Pi : ia n EoE m0 <br /> I declare that this application(i icluding any accompanying schedule)lhakbeen examined by me and to the best of my knowl. o m <br /> edge and belief it is true,correc t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0 <br /> further accept all liability whict 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 cou ty officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE (date) <br /> 1000 , <br /> (si t eof ow ror building eon[ractop (date) 18ZONING ADMINISTRATOR 4 H1M)TOWNSHIP PERMITS MAY BE REQUIRED of N � N�IZIm 0 ® 9 Cn <br /> » x x x <br /> 0 <br />