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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m c c <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and .2 w <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 o <br /> regulations of the State of Wisconsin. H m <br /> w � <br /> i� l G C m iii <br /> o <br /> OWNER Dli, L Itc CA1 (_ C. I� TELEPHONE t1 /r 1._:�' J �7�. �/ [/ 6 0 <br /> is <br /> ADDRESS 13o Sowfem tit 53167 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I�OI!/Na �n2PeN Pi)ifcl <br /> LEGAL DESCRIPTION (see tau receipt) n;,,,:r/ Vit, 5-9c3:? T 3 "'N-V1((l,' 4S'IC <br /> CONTRACTOR S.Q, i <br /> I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> o -- <br /> m r- <br /> STRUCTURE/ADDITION USE: S^T,o r2 A—C— ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> a <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 dralnfield (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. 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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o rn <br /> PLOT LAN A o or <br /> - M <br /> Cay rx' IZi� <br /> f w <br /> 3 0 ' C_ <br /> � t <br /> LN 6c2es �' - <br /> m <br /> � O y <br /> J I 'il <br /> 1I � <br /> � _T� 2 <br /> Mw <br /> is <br /> �, oc =.wmo ng <br /> vz . �_ <br /> CONDITIONS OF PERMIT: 9 <br /> < Z ` C o m 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. I 0 m o 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ ° <br /> — i X1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Yn O m <br /> w E C <br /> DP (including Yaccompanying 1 y g ` <br /> I declare that this application mcludin an schedule)has been examined by me and to the best of m knowl- E m'e <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• <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. Ii t 8 u 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have i i <br /> access to the above described premises at any reasonable time for the purpose of Inspection. '• w Y <br /> m ' vA <br /> rte^ m i o A <br /> SIGN HER ` <br /> ( na of owr building co rector) <br /> ZONING ADMINISTRATOR <br /> i 1 - - ~• w y� m <br /> TOWNSHIP PERMITS MAY BE REOUIRED µQR S �d�m' & • o IS m <br /> 888 (Mn8 <br />