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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator OV C O0_ <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2. <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a $ <br /> Burnett Cour'dy,Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regul4(ions of the State of Wisconsin. w m <br /> a e <br /> OWNER �Ita/�' cr� S � ac_ A+a TELE/PHONE / aa <br /> 74� <br /> £ <br /> ADDRESS <br /> + / /Ql/V f Sf/�/ G✓A'TEh �/L, .S.SDd-a 0 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME S, (�Oh4Nd Vti �,k kd 1 <br /> LEGAL DESCRIPTION (see tau receipt) pc l V r �,� 5 rt(o sCG oc.,f I ldN� I� �Lj 3r 'Q <br /> CONTRACTOR G IGY'.S&AJ 'SI r rn <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p V , <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 1o <br /> STRUCTUREADDITION USE: �WGl {lA3COl LA o a <br /> (Home/Cabin;Commer I Business;Bedroom; Deck;etc.) <br /> r <br /> Z <br /> 0 0 <br /> m t <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 v m <br /> PLOT PLAN o n <br /> 10 � <br /> See (/a,1/� n y9% : <br /> '" ; <br /> W a <br /> s <br /> I� <br /> m <br /> r <br /> w <br /> O <br /> � Z <br /> n <br /> r � <br /> f <br /> R �?T-on�asom <br /> �. m <br /> CONDITIONS OF PERMIT: me Q CS gr ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. gN 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �' h : m <br /> E : O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- '• sr�� ? a <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- R l $ ; m m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $Y $ <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 <br /> access to the above described pre INs at any reasonable time for the purpose of Inspection. <br /> T <br /> M Y <br /> SIGN HERE ' w i <br /> (sl u of owner or but Ing contractor) (date) <br /> ZONING ADMINISTR E E g E E <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 8 $ $ 888,$ <br /> urx senr E a-c y <br />