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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn 'D --I I Z <br /> M ° ° <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y C <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. o <br /> �/`` ` y <br /> OWNER TELEPHONE f <br /> GRr i A /3, f-lrcttA �-2s 84.6 y�s s�� �/� /.� v <br /> ADDRESS /dre> wr^s: �!a�7' A✓ct;J �,: P,�1✓t, .Rs.� s %a8 m <br /> 10/ LdJ L4niLr /Lol�p y/a nJiS✓/L 'T chi .s'y��v <br /> EMERGENCY/FIRE NUMBER ��TS ROADNAMEAy1..jAj0.j c .fe4 <br /> LK- <br /> LEGAL DESCRIPTION (see tax receipt) � Di <br /> Cd rJ L ©i #f St�Gi7o•Y i <br /> CONTRACTOR <br /> �� Go.rJ S i`7�.cJ c 17 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION X p <br /> 0 0 <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: Ay0 di�oS gam,7, �� /�el.�l.C�=s ss✓S o ° I` <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <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 (VI),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 0 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I <br /> PLOT PLAN 00 o a <br /> ft> o <br /> d <br /> >/ov/ Pr�posz I ^ c , <br /> �_ <br /> Ve �T <br /> s <br /> i�1:P <br /> N <br /> O r� <br /> 7 J]�✓/ <br /> 7 <br /> AQ�iQr SP�P d,R. L-Gt 5 �. <br /> 7 5 U — 7-0 <br /> ;1 <br /> a6 A 1 <br /> %D 7S' /0 MO _ <br /> CL <br /> CO S OF PERMIT: �f/�f/�QG(J ���� < Z C 6 <br /> 1 RIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 5' T <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. w �C <br /> g ; o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m I m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- En w E» ; O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 i3 .cNn <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m <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- Z' ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have n P o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ N�3 : <br /> x : <br /> fD N A N <br /> SIGN HERE <br /> (signs r of owner uilding contractor) (date) <br /> / . o x : <br /> ZONING ADMINISTRATOR "`t t 8 <br /> 6 = <br /> TOWNSHIP PERMITS MAY BE REQUIRED �►N N N 8 8`" M <br /> cnp+ cnoP . . - m <br /> 88888888n <br />