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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The here undersigned g by makes 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 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w d <br /> a m <br /> c <br /> m <br /> OWNER I nQL /f flowD TELEPHONE 13�-- ac33 n <br /> ITT <br /> ADDRESS b y 0456< S POGi1/G R w 1' e v <br /> �Tyl✓'�/ rP�SK � Q <br /> EMERGENCY/FIRE NUMBER / ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) //1s10.¢y 3y/ y6.� J� C t ___3SzSrzn 'Z,P/4 <br /> CONTRACTOR Ci4'e �IpN`1 iid <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDrnON�� o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 » <br /> STRUCTURE/ADDITION USE: ��r?+4 w�DOf DINGS LNT/P/YIA/C/—� o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> 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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 6 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ON 3 m <br /> PLOT PLAN o n <br /> m Ujo <br /> 3c' , .2 o7. sro��' 1" <br /> Of i <br /> aa� tw�L w �lNv O <br /> Nva/ <br /> K_ '/54 o <br /> N DME r/ <br /> WrtL o' <br /> rpN�• <br /> I o <br /> cvr <br /> m <br /> yj <br /> ( o � <br /> NES✓ orcK •✓/ROo> <br /> WEI t'Wt°R hdG TU CNT�Phr✓C� <br /> r)(cFf i <br /> jJ Z <br /> i lr <br /> M o c o m a g ,a <br /> n <br /> 00 am MM <br /> CONDITIONS OF PERMIT; o m Z <br /> o c o= <br /> o o ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 o' ? � : : -1 <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. rii 62m0 <br /> PP (including Yaccompanying 1 Y Y g : ` n " C <br /> 1 declare that this application Includin an schedule has been examined D me and to the best of m knowl- m o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- = ' ` y!o '• <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 7i m 9 i p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g' <br /> g <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 " ' <br /> access to the above described premises at any reasonable time for the purpose of inspection. m•' <br /> m v A <br /> n . <br /> SIGN HEREC- <br /> (a' na owner or in9 contractor) <br /> o <br /> ZONING ADMINISTRATORIn <br /> TOWNSHIP PERMITS MAY BE REQUIRED i I OCT 2 9 1'192 # m <br /> 8888888th <br />