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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator of (D <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m Q <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> 0 <br /> regulations of the State of Wisconsin. �, m <br /> OWNER TELEPHONE <br /> ay ' � uf- c /q (D2- - 02-, 7644 <br /> ADDRESS 427o ,Oc,G ))N .SS/ 76 m <br /> 0 <br /> EMERGENCY/FIRE NUMBER �;tr Z922 Lf 14A"�. ROAD NAME Co RA9x y w <br /> LEGAL DESCRIPTION (see tax rec�rei`ipt) <br /> 70 <br /> CONTRACTORS�E <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> r J <br /> STRUCTURE/ADDITION USE: Rr-10LX� l STEloSCO Z- A/1C'4' a o <br /> (Home/Cabin;Commercial Business; Bedroo ;etc.) Z <br /> o 'o <br /> 0 <br /> m <br /> D <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). <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 <br /> dated by the owner. fj o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 a rn <br /> PLOT PLAN <br /> o <br /> sfF� ; cfl'rs - , <br /> m <br /> -7oFf rl?,,Hr 4� <br /> 13 s,F,Os t 5 T�Ps 7-d N41E <br /> 20 LoyG I [� o <br /> 33 <br /> ? / <br /> SU FT <br /> RD <br /> I N E8 v ( TO j?vre-D/NG <br /> Lcr LINE <br /> m �c��i �DaOV <br /> m DFL22..n� 110 <br /> CONDITIONS OF PERMIT: a N. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'No 6 : m <br /> 0 . <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 informs. `w m v. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- `.b' a p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I oo <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 0" p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> N O A w <br /> m O <br /> M O : <br /> SIGN HERE <br /> (at of owner wilding ;I a L' �� [ 8 <br /> ZONING ADMINISTRATOR '^ r I iAU13 L4 <br /> NN <br /> TOWNSHIP PERMI Y BE REQUIRE j JUL15 `� ' g N N N N p N m <br /> 00000000O <br /> I <br />