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Cw <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m1+z <br /> m m o Z. <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> - <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for 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 3 n <br /> regulations of the State of Wisconsin. - o <br /> m <br /> c <br /> OWNER TELEPHONE n FO <br /> �OLFtA �Ga K�. (o3J -3`F3o e✓ QI33 <br /> d <br /> ADDRESS <br /> 25q-72P-Y <br /> EMERGENCY/FIRE NUMBER ROAD NAME D <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) `n /� n w t/� �) f?j�✓i Imo(,/.� 51� 1 <br /> CONTRACTOR <br /> I\ Odd"""444�"vvY rr'� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGF/ACCESSORY STRUCTURE ADDITION p F <br /> (^ <br /> SANITARY PRIVY PRIFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> TRUC�ION SE: iE'- 't' QtQ[Qik lrrx�l'C�111fT v }7P� o <br /> (Qom abin;Commercial Business;Bedroom; Deck;etc.) Z0 <br /> u <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 (W),septic tank (ST),and drainfield (D17. <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 2 �. <br /> dated by the owner. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on ur <br /> O c <br /> PLOT PLAN Q o a <br /> 90 <br /> I�S t9c1� CCL ° <br /> o � <br /> I � <br /> N <br /> IP' J <br /> N S <br /> p e� <br /> J <br /> J <br /> b <br /> m <br /> n <br /> y Z <br /> 4— <br /> f <br /> M �ryr�(nr D DO <br /> c �. m OO <br /> o a00 Mim <br /> CONDITIONS OF PERMIT: c m ,z CS ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -N' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' m a 2 : A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> 0 m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o <br /> further accept all liability which may b a result of the County of Burnett relying on this information I am providing in this so- ' <br /> plication.I agr to permit county of ci Is charged with administering county ordinances or other authorized person to have N p <br /> access to the v ascribed pre is at any reasonable time for the purpose of inspection. <br /> m 3 0 <br /> ' b A N <br /> SIGN HERE L /� ^ w a$ <br /> ( ig ature of <br /> ZONING ADMINISTRATOR <br /> TOW HIP PERMITS MAY BE REQUIRED <br /> tt !! r <br /> ,F1,vJ ( .uNitoo <br /> N m <br /> o 0 <br />