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Oil C��rr�7 , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m rn <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a V 1 <br /> regulations of the State of Wisconsin. N o <br /> c <br /> OWNER Tethy S.neCAa TELEPHONE (775) 866-7534 a o <br /> O � � <br /> m tD <br /> ADDRESS Sox 478 NebsteA, WI 54893 m <br /> EMERGENCY/FIRE NUMBER L7949 ROADNAME County Road T OI <br /> LEGAL DESCRIPTION (see tax receipt) <br /> pct. NEr Nom, Sectian 25, T40N, R16W, Town ax Uoh2and � <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> ^ r <br /> STRUCTURE/ADDITION USE: $IX,n2iChCf O!'beV o °• <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> 0 0 <br /> a <br /> a V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) J ` <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). o <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building 11 (0)1 <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. '1111 a ur <br /> c <br /> PLOT PLAN o a <br /> Z <br /> f11 y <br /> C O �1 <br /> I <br /> _O - <br /> I � <br /> SEE ATTACHED , <br /> o <br /> 1 <br /> o <br /> V <br /> I Z <br /> I <br /> �. O M <br /> m m em <br /> CONDITIONS OF PERMIT: <br /> v mN.� ,2 cg 0� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o :E <br /> 0 I : 1 <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. D <br /> g : E! C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : «y a: T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 3 o i o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 0 0c <br /> 9 <br /> SIGN HERE <br /> ,,) de u.ryhn,o 10 4 93 <br /> (signature of ownr uil contr (d e) `' <br /> fi� m_ <br /> O ; <br /> ZONING ADMINISTRATOR Jmn&= 0 <br /> TOWN IP PERMITS MAY BE RED % OCT — 5 .c� o« «N N m <br /> u <br /> 0 0 0000 <br />