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el l.lZ74 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 10 m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c � C� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> OWNERTELEPHONE� 2„ � `10 (Z^ VEGRE VoTmM a O <br /> O <br /> 7� u m <br /> ADDRESS IX 2_L49 1-� �I�e C(� M 0(03 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> C ^ <br /> LEGAL DESCRIPTION (see tax receipt) I `u1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 <br /> SANITARY ^ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> J <br /> r <br /> STRUCTURE/ADDITION USE: o °_ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Zv <br /> 0 0 <br /> 0 <br /> m <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. Ill" <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> PLOT PLANZ <br /> � o a <br /> M <br /> Cto <br /> ' <br /> �f1'flct!£p M 11J <br /> I <br /> I <br /> 0 <br /> IIJ-� <br /> N I <br /> O Il}' <br /> J <br /> LU() y <br /> I _ <br /> Z <br /> f� <br /> N <br /> D ri OV(n r-DD0m <br /> g "'> > o a� m <br /> XI <br /> CONDITIONS OF PERMIT: c m- c ii 9' <br /> < 5z88Do r. <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F oi: M•2 : - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> u it2 € m <br /> O <br /> mB C_ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0^ ; <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «.m»: M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o`$ o <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 haveO a o <br /> access to the above described premises at any reasonable time for the purpose of inspection. - <br /> m ao <br /> N e A <br /> SIGN HERE <br /> (signatLire of owner or building contractor) SEP 9) <br /> {da fe ' <br /> 4. o � <br /> ZONING ADMINISTRATOR %1 ' p $ <br /> w d "e, n <br /> TOWNSHIP PERMITS MAP 8 1. mY BE REQUIRED _ N <br /> 0$ o o N <br />