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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' o c <br /> APPLICATION FOR — LAND USE — PERMITS 3- 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m °- <br /> Ig by application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 2 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. n <br /> m <br /> C eR15Lu <br /> EOWNER �2r� ?e+eRsoK, TELEPHONE 7636 m <br /> ADDRESS Z 71?3W CAyii 'pGD We54(44_3 <br /> EMERGENCY/FIRE NUMBER 2 793('] ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) -i-•fi c0� rD rb CV <br /> CONTRACTOR ,�.1n�C� to Ip ! 1 rC-. <br /> TYPE OF PERMIT(S): DWELLING?/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> _ O It <br /> o ' <br /> v� r <br /> STRUCTURE/ADDITION USE: 'yam A"j o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> v <br /> m <br /> 3 <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). <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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I P N <br /> c <br /> PLOT PLAN 9 A o a <br /> M <br /> l N <br /> 0 <br /> 0 <br /> m Iv <br /> o <br /> N <br /> Z <br /> o c m o o a g m <br /> CONDITIONS OF PERMIT: Z j Q goo 02 M33 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m c : 0.2 : —{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f ' 1 ;11 rn `. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ieii i G) n m <br /> P (including Yaccompanying ) Y Y g' C <br /> I declare that this application includin an schedule has been examined D me and to the best of m knowl- o i i m o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I [ g u 8 <br /> further accept all liability which may be a result of the County of Bumett 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' m <br /> 'nf 3 $x <br /> SIGN HERE /D m <br /> / <br /> (signature of owner or bulldin ract (d e) a <br /> i i <br /> ZONING ADMINISTRATOR ! ` g l ` <br /> TOWNSHIP PER TS MAY BE REQUIRED m <br /> 88888888rmn <br />