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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m M a o <br /> APPLICATION FOR — LAND USE — PERMITS2. 3. <br /> m D <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 00 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. y o <br /> w m' <br /> c <br /> OWNER TELEPHONE(6IZ) 73 / <br /> _ 31 1 <br /> ADDRESS A inller erew InAl SM2 57- <br /> EMERGENCY/FIRE <br /> EMERGENCY/FIRE NUMBER ROAD NAMi <br /> le—� zow , oyea <br /> O <br /> L <br /> LEGAL DESCRIPTION (see tax receipt) <br /> / L <br /> CONTRACTOR r0 / ,fec ''vt` Zlr y0/✓ ,�/6�✓ •Tc.�•� o Oa.rd�,�t. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGFACCESSORY STRUCTURE ADDITION p <br /> M o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> r <br /> STRUCTURE/ADDITION USE: P C— g <br /> v <br /> (HomelCabin; Commercial Business;Bedroom;Deck;etc.) Z o <br /> O o <br /> 3 <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 drainfiaid (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. 0 <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a w <br /> PLOT PLAN 1A Z <br /> o n <br /> m c <br /> M w <br /> t � <br /> 0 <br /> J N <br /> 0 <br /> N <br /> 0 <br /> O � <br /> N � <br /> Z <br /> I y <br /> SEE VARIANCE #430 CONDITIONS: The deck setback is not to be used as a setback <br /> average and no enclosing of the deck will be allowed. <br /> ]] NcnV (nr DDO ll <br /> D o c J. m m c a d m <br /> CONDITIONS OF PERMIT: 0 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o o <br /> F r 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a r» : m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> g� : O <br /> i E : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa O <br /> m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i m N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g 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 havem v <br /> "' <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> . ' <br /> T A H <br /> p A � <br /> SIGN HERE <br /> i t e of o er wilding contractor) (dale) <br /> ZONING ADMINISTRATOR � �1." <br /> TowN JUN 2 3 1992 N N N w <br /> SHIP PERMITS MAY BE REOUIRE I'; <br /> T <br /> G N N f a O N O m <br /> 88888 9 v, <br />