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N C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Aftly iistrator mm c o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> ro <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work des ibed and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem ms of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and thelaws and E <br /> regulations of the State Of Wisconsin. w v <br /> c <br /> 1 (J c O <br /> OWNER 7 , 0 TELEPHONE C - Yd O' _ �ry a f <br /> ADDRESS /2 926 Cd Pj --rcw s�i Gig n Au OSy,?C/6 m -C- <br /> EMERGENCY/FIRE NUMBER /1116 <br /> Q G ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)5w/ 0 � G'Vj 1 o r Se ro / IIII""/LGG0,0'?S�' 37 Ov f�17 <br /> CONTRACTOR J W g <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_X GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING LA <br /> CAMPING UNIT SUBDIVISION r^ o <br /> pp 0 <br /> STRUCTURE/ADDITION USE: dm� O t L— W Id t +� g °. <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> Z o <br /> 0 v <br /> m <br /> a <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 Nor h (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (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 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be si ned and M <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 0 v N <br /> PLOT PLAN a g <br /> See 4,,, ysi ur S� qtr - T N <br /> 0 <br /> C i <br /> N <br /> i <br /> <; I <br /> --- --- p o <br /> I <br /> t I <br /> i J1 <br /> - <br /> ��r� Z <br /> U; ' oU <br /> o � <br /> > 306 <br /> Com .( O ^l''C (D— Q 1 D$: m <br /> CONDITIONS OF PERMIT: _ _..-.-. QUe,y' T '"Ny �.oT Ifh'L. g, �4 2.a -,m y <br /> 0 (/ a m3:: c g � <br /> ST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. —cc : <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u I m <br /> E ; O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of Tly knowl- EO s3 i C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of I informs- d u m'^ T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ B <br /> motion 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 ordinances or other authorized per34 in to have <br /> 0 : p <br /> access td the above described premises at any reasonable time for the purpose of inspection. m <br /> n 3 <br /> SIGN HERE � <br /> (Sig u of own ulldfng contractor) (date) <br /> ZONING ADMINISTRATOR [ $ '. '. <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> , 888 <br /> 88 8 0 Ilr Op pN U 1plr <br /> 0 <br />