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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m a 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a rermn rx Ins work.,o....,, w o c <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 o <br /> regulations of the State of Wisconsin. c m <br /> f/ QO Cr $ <br /> OWNER JaNLS Kq EMN E'R L►NCr TELEPHONE ay6 -- s6O m <br /> ADDRESS 1-724 `-(p1-H ! T. VEW RWH"60 &J 5 //0/-7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME EO( Rb - - <br /> LEGAL DESCRIPTION (see tax receipt) N%L ./ /J/_L N 0/y SEC c70 T'W P V0 JIMA)&h f <br /> CONTRACTOR 19 l /-' =9 , <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O ��\ <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> 0 0 <br /> STRUCTURE/ADDITION USE: l� <br /> artist Business;Bedroom <br /> (Home/Cabin;Com O <br /> ; Deck;etc.) Z _ <br /> p <br /> A <br /> 3 <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 (N),septic tank (ST), and drainfleld (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 O <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1A v <br /> o Z <br /> PLOT PLAN A I <br /> C 1 <br /> / DJ( kid, M <br /> Mqj <br /> O <br /> I <br /> v, <br /> 0 <br /> 7Sr <br /> o <br /> t:A81N <br /> m <br /> o <br /> 0 « f <br /> N <br /> PRIVY <br /> r ARfAaY 1 <br /> f <br /> R X' Ir m <br /> g Q C 8 'R, ; <br /> CONDITIONS OF PERMIT: Z i =11. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o °E stn: M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O ? m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> - ' C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. - e, « y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- e m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- g 8 ; t7 <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a penult. I , <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 acto permit county officials charged with administering county ordinances <br /> s o other authorized peroon to have - <br /> access to the above desert ro <br /> Pmiess N any reasonable time for the purpose Cf inPec ; u <br /> SIGN MERE dractoo �,I (date) <br /> ZONING ADMINISTRATOR I -91491R <br /> r.M N h T <br /> TOWNSHIP PERMITS MAY BE REOUIR P 8 R `" m <br /> 888888188 m <br />