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AW' 3yq a 138 OK (u"P , <br /> fumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d <br /> J THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and -2 - <br /> cated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> imett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `> <br /> agulations of the State of Wisconsin. 5 m <br /> T �7 �- m � <br /> OWNER 1 1�'(/��- '/� sC y -�/J�/k�L-� TELEPHONE ( �- 7-2 a V) O <br /> ADDRESS � ( UL 0 m <br /> EMERGENCY/FIRE NUMBER o77�J^ ROAD NAME <br /> Na <br /> LEGAL DESCRIPTION (see taz r�eceipt) <br /> CONTRACTOR -T,41 �fE s <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° , - <br /> / J - <br /> f�D�c <br /> STRUCTURE/ADDITION USE: � o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 0 <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 ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building 11 <br /> measurement to the ordinary high water mark of lake,stream,or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a N <br /> 11 z Q <br /> PLOT PLAN A o a <br /> M o <br /> --- C <br /> M = <br /> wwa C —. <br /> w . y 5 � 7anK o W <br /> E b <br /> Z <br /> C' <br /> �///�//l 7 <br /> � <br /> c N m n a <br /> C� j <br /> CONDITIONS OF PERMIT: m Z o�, 'S ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e F mi <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. o ia O <br /> E <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- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 012 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 0 N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 0 <br /> Q V A N <br /> 0 <br /> SIGN HERE 1-��� / `C d 93 «. <br /> ignature of o r r b 1 ng co tor) <br /> � o : x: <br /> ZONING ADMINISTRATOR 0 <br /> enww�wen Fn v. 'T <br /> N N W N N N J Rt <br /> To SHIP PERMITS MAY BE REQUIRED o o b u b o O u <br /> 000000000 <br />