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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to 0 <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 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the mc, U <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. y m <br /> w <br /> //�� c (� O <br /> OWNER /�g,lt 14 S kJ,bAL sPL J �i TELEPHONE (B�,j_ 7;./�?.28 6 AI o m <br /> ADDRESS 3t <br /> EMERGENCY/FIRE NUMBER ROAD NAM ./ _ r e �J <br /> LEGAL DESCRIPTION (see tax receipt) /` O: / -�� Be�t°S ��L�r� f70R lC <br /> L. <br /> CONTRACTOR 0 0 1 )4n 1 "=�I n „yI S. ��-f-/�' �SJf{i4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING J_ C I CGGA`RAGE/ACOESSSOORY STRUCTURE ADDITION p <br /> n M <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> ° < <br /> STRUCTURE/ADDITION USE: 14 DWr Q $ 3 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> z o <br /> o c <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 drainfield (DF). R <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building -q <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 <br /> dated by the owner. O c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 1 <br /> c <br /> PLOT PLAN o ae <br /> Sic �jc,�rtr M <br /> 0 <br /> Ccli. <br /> m <br /> .rte i✓ C �r�ems, y/a 9� <br /> �1 = <br /> �o <br /> b <br /> O y <br /> N <br /> Z <br /> Z <br /> I <br /> G <br /> R K 2 <br /> CONDITIONS OF PERMIT: a '<_' ' m C '.1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 ? r� <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. tR pm " I C <br /> $ c <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o tom W m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all intorma- °qq! m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- � 25 R N <br /> m <br /> mation 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have 00 v, p <br /> access to the above described premises at any reasonable time for the purpose of inspection. nom 8 2 <br /> T V A N <br /> SIGN HERE <br /> N <br /> (signature of o orb ' ntr I I � � Ft� <br /> ZONING ADMINISTRATOR - <br /> TO NSHIP PERMITS MAY BE REQUIREDN <br /> JUL - 2 1992 9 0 ® 0 8 , J <br />