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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m a, <br /> APPLICATION FOR — LAND USE — PERMITS _ > <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 0 I <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. — R \ <br /> I J <br /> OWNER m O <br /> bw irti E. TO H N 50M TELEPHONE G,�2-626 - 4 9(01} a £ <br /> ADDRESS Z,qqO Moan" Ncw ,( glawTON Mnl. STI 12. <br /> EMERGENCY/FIRE NUMBER 3/195' ROAD NAME J3UC W <br /> LEGAL DESCRIPTION (see tax receipt) <br /> see, 13 /7-W VIR <br /> C °d <br /> CONTRACTOR �/.CTiS/L�it/� Q ��4E�s, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X _ ADDITION�_ o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o` < <br /> r � <br /> STRUCTURE/ADDITION USE: 10/fI y r <br /> o � <br /> (Home/Cabin;Commercial Business; Bedroom Deck;etc.) Z 'n <br /> o <br /> CD <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) a <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 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 A <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. 00 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMITCAN BE ISSUED. an v <br /> PLOT PLAN in Z <br /> Z <br /> n o <br /> �Lr 6R M o <br /> a <br /> o/ M <br /> A <br /> / 90 'Al -+ !!�� /ori� <br /> R <br /> _RDF m <br /> Com--- <br /> ��'b s <br /> 0 <br /> v, <br /> ,d pdiT/O�IJ o <br /> t - <br /> < zau <br /> Z <br /> i 7-,e'-4er <br /> 4e4- <br /> 9/4 5 <br /> 4-9/45 f <br /> �/'• �� l�ln�rnrDDO <br /> cmCM.; � 0a: m <br /> CON MO F PERMIT: a m y;: Q c 8 z5. $ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c 0 �Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (SG)2M m <br /> Oe ?o D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- �E _o 13 <br /> C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all <br /> informs--u <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• $ t3 m M <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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 i n N v <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 a m <br /> � m i0 <br /> SIGN HERE ``c-� �RAAS_® <br /> (signatur of 1 owner or build' contractor) (date) <br /> ZONING ADMINISTRATOR � <br /> OWNSHIP PERMITS MA BE REQUIRED �� N m <br /> 0 0 <br /> /_7 <br /> 0 <br />