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a? <br /> Burnett County 7410 Co. Rd. K. No. 102, Siren,WI 54872 Office of Zoning Administrator 0 m f o <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THt ZONING ADMINISTRATOR:The undersigned here makes m <br /> ndersig by application for a Permit for the work described and � rn <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable Courtly Ordinances and the laws and W <br /> regulations of the State of Wisconsin. w m <br /> m ,T <br /> ` <br /> O <br /> TELEPHONE DY1 <br /> E <br /> ADDRESS ZZ50 6110-A J <br /> r{3 . /VIA) '5�17 <br /> EMERGENCY/FIRE NUMBER ROAD NAMEA <br /> LEGAL DESCRIPTION (see tax receipt) Tds Y�V <br /> L J `i C VE f I J = 4. <br /> CONTRACTOR 6L L-f: 1AC IMM <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE__X_ ADDITION p <br /> )( 0 -1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo (O <br /> STRUCTURE/ADDITION USE: tom- o °— <br /> (Home/Cabin;Commercial Busines ,Bedroom;D k;etc.) Z o <br /> o <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 (VI),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions in feet of thefollowing:(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. <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. 0 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 11 o to <br /> PLOT PLAN �bn al o a <br /> � N <br /> 0 <br /> t kg►fs -35'Ksa' 1 <br /> tA <br /> -7 7-l <br /> --� - s <br /> o <br /> --f�>;i l 1 <br /> 'URAO <br /> o � <br /> TRIu�Y � 01 1 z <br /> CN 6)UA* <br /> 1/q- MILS <br /> L. 6rJ <br /> nnra �E <br /> 10 <br /> 1 W. 172.am <br /> CONDITIONS OF PERMIT: �IafJle �' o < Z.` Q C8 <br /> g T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 5 z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o O 0 ? D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 400 h m <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. $� $ <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.1 agree to it county officials charged with ad stering county ordinances or other authorized person to have p <br /> access to the above cribed premises at asonable file for the purpose of inspection. <br /> � i a <br /> SIGN HERE <br /> k4o A MVIJ � -s <br /> (signature o owner or building contractor) - (date) <br /> ZONING ADMINISTRATOR F4 <br /> TOWNSHIP PERMITS MAY BE REOUIR �1 i;; $^' '8 m <br /> ami <br />