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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn -+ Z <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> m 3 � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 3 n <br /> regulations of the State of Wisconsin. o <br /> fIi N <br /> w � <br /> OWNER QR AF N)A�I.IL "f'L I ^C( o. <br /> TELEPHONE iD� L_�{J10 <br /> ADDRESS A r`(' <br /> 77CCC t <br /> EMERGENCY/FIRE NUMBER 289�Z ROAD NAME C', � �� <-7 _ O L r^.,� <br /> 1 /'� JW t«- 1 �� <br /> LEGAL DESCRIPTION (see tax receipt) /.�, L' .71 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING N/ GARAGE/ACCESSORY STRUCTuaE__ ADDITION p <br /> SANITARY�_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> D <br /> N <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). o <br /> 3. Show dimensions in feet of thefollowing:(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 <br /> dated by the owner. 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in o N <br /> PLOT PLAN E Z Q <br /> oogrj Sed bWK-S. m o <br /> 14 Am LA C <br /> I <br /> I <br /> VIA s7 O <br /> r20L9 O <br /> 1 ` <br /> 0} N <br /> 0 n <br /> O <br /> 0 <br /> N I f <br /> 0 <br /> `�AIti I Dy4'� i'\vl1 <br /> / r NO ~ <br /> n <br /> No EB <br /> �u SkIED J Z <br /> \ $` pozopi RTY C INE <br /> 0 *$r *W ra Sce rT-H <br /> `J aI c0�;0a� m <br /> ` 0 g� 0 m m <br /> CONDITIONS OF PERMIT: ��` 1VA IP o m Lo' Z C8 = i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIREMENTS WITHIN 60 DAYS OF PERM ISSUANCE. o s 0 - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =Ni i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �n 39 , m <br /> Oi E O <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- a y u. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor B <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <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 N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 g <br /> N m A N <br /> SIGN HERE <br /> (signature of owner or buildin ontractor) I t J \o/ I <br /> ZONING ADMINISTRATOR <br /> $: <br /> j' <br /> rn vT a to fn to vw -1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED JUL Q %i o N N N N PriN m <br /> 000000So fes// <br />