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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m a l o <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 v <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. v <br /> N m <br /> �/ N m^ <br /> OWNER BERWARO MEYER TELEPHONE ��� - 8ys� m �£ <br /> ADDRESS 3303 LAKE ELMA AV. t4Ki5 je'/., itle Mn/ _5yoYZ rK l <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR C <br /> v <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X m ARAGE/ACCESSORY STRUCTURE ADDITION p <br /> M <br /> SANITARY PRIVY FILLING/GRADING CAMPING, UNIT SUBDIVISION <br /> 0 <br /> STRUCTURE/ADDITION USE: T_ o <br /> (Home/Cabin ommercial Business;B room;Deck;etc.) Z ° <br /> 0 a <br /> a <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 dralnfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building - N <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 <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in v yW <br /> PLOT PLAN Z <br /> o a <br /> C , <br /> M <br /> m \ � <br /> ( N <br /> m <br /> A <br /> O <br /> rn� <br /> 0 <br /> � Z <br /> y <br /> M o c M. m sr+ a as ! m <br /> x a m a 31 <br /> CONDITIONS OF PERMIT: o 3_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o . .T'Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — N i m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m 2 C <br /> g : a $ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- w m ec O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mationI am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 8 <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. a w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i S,U O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE 121-17 /C�Z- 'm 8 <br /> (signaturef of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR . J1IM1'I Elam lafl_ 06T. I n 99r) <br /> TOWNSHIP PERMITS MAY BE REOUIRED (�N " <br /> N N N "o 8 8 9 m <br /> 888 8888x, <br />