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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N <br /> ( olo7mz <br /> APPLICATION FOR — LAND USE — PERMITS - _TO THE ZONING ADMINISTRATOR:The u reed here makes <br /> ndersig by application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> OWNER J.4CK i K.4rHy PETER SOA( TELEPHONE 71S/ 65 s��o t/ e 0/ <br /> 7 mm <br /> ADDRESS 17- <br /> 1"196 SWISS �J�/1LET �D_.. � 7/ 4 <br /> EMERGENCY/FIRE NUMBER 11196 <br /> ROAD NAMESM//_Is cwL,,F-r RA <br /> LEGAL DESCRIPTION (see tax receipt) CSAI Jd `�,� S2C- T <br /> '�'3�n/ R I I t,,,) <br /> CONTRACTOR NENDERSOA/ C.oNST,QlleT/D�/ '-- 0 ��� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY fnj FILLING/GRADING / CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: LJi¢TiYRoDM ( DoRME2 $EGO.VO FLOoQ / o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o / <br /> o c �1 <br /> M <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)4 <br /> 2. Show the location of the well (N),septic tank (ST),and dralnfield (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 .4 <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. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. a v A <br /> PLOT PLAN r o n <br /> C N <br /> I J <br /> a � <br /> 0% o <br /> u �pRoiC . SEcmA/D F"'OA JA/ I <br /> 7 <br /> 28 ' <br /> APRox C: <br /> ys r � 9� � <br /> I <br /> m <br /> 7� o <br /> N <br /> zy' tJ T' <br /> EB <br /> DF <br /> �x <br /> E g FP. VF'j0m <br /> o $� a� o <br /> CONDITIONS OF PERMIT: v3; C g ; <br /> 1. DRIVEWAY MUST MEDRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS Of PERMIT ISSUANCE. c f ' �Z . =1 <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. m <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my kngwl- E S E <br /> ? � ` r <br /> ed a and belief it is true,correct and complete.I acknowledge that I am res - m <br /> 0 p g responsible for the detail and accuracy of all infor0a- E «a « ; <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this in or- <br /> matlon 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 am providing in this ap. <br /> plication.I agree to permit county officials charged with administering county oMinaneea or other authorized person to have ` <br /> access to the above described promises at any reasonable time for the purpose of Inspection. <br /> P . . <br /> SIGN HERE <br /> P4 exkv�"� G�2O 9� « ' a <br /> pl tlu)ft of owner contractor) (dib) <br /> ZONING ADMINISTRATOR $ <br /> - NMMN <br /> TOWNSHIP PERMITS MAY BE REQUIRED 9&g 9 9 0'g m <br /> 888888,818 ami <br />