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l`V COMPUTER/SCANNED () e�&Y' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( -0 -- a <br /> APPLICATION rOR — LAND USE — PERMITS <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ; _ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and a I � <br /> regulations of the State of Wisconsin. �, w <br /> N <br /> O <br /> '/ <br /> OWNER ✓/ TELEPHONE f <br /> 1 v <br /> ADDRESS LTT/ / C /�D� /4/"g�TOAv_r // Aw S�/1� <br /> - <br /> / <br /> EMERGENCY/FIRE NUMBER — ROAD NAME <br /> I _ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE _ ADDITIONCD <br /> p <br /> a '0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial usiness;Bedroom;Deck;etc.) Z <br /> o 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. 0 ` <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1A <br /> Z Q <br /> PLOT PLAN o a <br /> Cr <br /> ISO \ y '� <br /> �4�Ib <br /> o <br /> 0+ \ <br /> ` <br /> N <br /> fl <br /> � Z14 <br /> I Z <br /> �46,� <br /> I <br /> (n-ofnrDDO -0 <br /> fD• p_'G fir Q.y --T. m <br /> CONDITIONS OF PERMIT: .0 :3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o E 2 : m <br /> 9: aka: C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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 <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 <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 have w <br /> access to the above n e remises at a able tim for the purpose of inspection. 3 0 <br /> �t o <br /> 01 CD m <br /> SIGN HERE `• � <br /> (stia�u e of owne r ui i contractor) n `' {date) <br /> / (J x : <br /> ZONING ADMINISTRATOR �` 0 : X <br /> fn En to x -n <br /> TOWNSHIP PERMITS MAY BE REQUIR AUbI�M � � W � mi <br /> _- ------- - 0 0 0 9 '0 <br />