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0 ` / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N o c <br /> APPLICATION FOR — LAND USE — PERMITS 5. - <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w 0 1''4 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirerr ems of the m c L) <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. w m <br /> c m ) <br /> OWNERTELEPHONE & 1Z-�P$ _ ? O £ <br /> m_ <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) S> 88pv I i� --- <br /> t� V <br /> CONTRACTOR I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 00 <br /> o <br /> N <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin;Commercial Busi ss; Bedroom;Deck; etc.) Zv <br /> 0 o JI <br /> 0 c <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 Infest ofthefollowing:(a) building to all lot lines,(b)bulldingto center line of road,( )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 2 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 rn <br /> PLOT PLAN o 'n <br /> y. <br /> (SOU •T- tar ,5 / S2 T1DA5 34C <br /> a � 3 <br /> TownSt+l(7 38 Nai71t, PAN- ISW�T, rc M <br /> ( apojer GouNTyr Gu I. /V <br /> NED I <br /> 640(tf-IPWO Su.Faue-1 <br /> U4M,G I PPRe tt <br /> Vm r FAbGa-� I fly k—'I 1!Ij�y R <br /> �i <br /> o <br /> Io <br /> N <br /> 9pAQ ?. <br /> I O y <br /> DDF_=D V 401 P 335- / O� M� <br /> W <br /> 7?,,�c447_ ZS <br /> 34 ozSro <br /> C, sP�l 6 <br /> �r F mw5� be pa A101 � f <br /> CONDITIONS OF PERMIT: <br /> mzCS NO M <br /> � <br /> 1. DRIVEWAY MUST MEET DR AY WID REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c £ . 1,2 <br /> : <br /> 2. REMOVAL OR CUTTING OF TR A VEGETATION IS RESTRICTED ALONG SHORELINE. it <br /> ! - ---y' A <br /> 3. NO GRADING OR SHORELAND AL TIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U, �' O m <br /> q i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ` o , i '• C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- 9J T <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 l grQ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am Providingin this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the abo escribed premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE f� ' <br /> (sip o owner or uilding contractor) I pl ____(_ ej <br /> 1 r : dot _ <br /> ZONING ADMINISTRATORMAT 4 <br /> TOWNSHIP PERMITS MAY BE REQUIRE' 4 I m <br /> 88888888H <br />