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Burnett County 7410 Co. Rd. K, No. 102, Siren,Wi 54872 Office of Zoning Administrator 5 m £ o <br /> APPLICATION FOR — LAND USE — PERMITS Im - <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <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. w m \ <br /> 7/5- (P5IS 36 LvA o g o <br /> OWNER C'�/R j?LE oA/LW NO TELEPHONE 7($ _ b3S - ,&pO olrtE <br /> ADDRESS T = .�a5r /,3 4 y �' o "^ <br /> e°A/8'R_ wr s $Y Popj / <br /> EMERGENCY/FIRE NUMBER ROAD NAME it � I ,� <br /> N/sa C.1,�d(.,,,gyp T nr<s <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Lo T / 9 Gc/��erw�a. sf��. r,,,✓ SEcr3- -� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE JO ADDITION C <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> STRUCTURE/ADDITION USE: To L/3XE o 0 �. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 ° <br /> o <br /> m <br /> } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and dralMield (DF). I o <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE IS3UED. on 3 to <br /> PLOT PLAN o \ o <br /> P r,-r o f,.:cera a <br /> ia`E6 ��C ;`' `a X117'` �flt�f " I�lla4 ►- x7 ' Ir (f <br /> i G <br /> RALL1 S.n�}GtiLV IN <br /> L� m i <br /> o .I 11 <br /> ' � <br /> iI 3 s( ro Oil �- J <br /> i <br /> 3 !o LAW vJrL1./L TLp <br /> NwL_ <br /> f <br /> R 9$* m <br /> a DZ`G 2.Cb Q 0 =I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = o 'z i 1 <br /> F = i € N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. bV kjv- c m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. - <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that I his infor- - <br /> motion 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 on providing i i this ap- <br /> o <br /> p- `• U(J <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pars n to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN MERE <br /> (signal oto nor or bu g contractor) (date) <br /> ZONING ADMINISTRATOR r - <br /> �I <br /> MMM+• <br /> TOWNSHIP PER ITS MAY BE REQUIRED o R 8 N N' N B m <br /> _ 888888 $8 ai <br />