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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m c o <br /> 'APPLICATION FOR — LAND USE — PERMITS 3. <br /> s <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. H m <br /> I v N v <br /> OWNER R 1C SI J {� r ,..1 (2 N// TELEPHONE 61 <br /> o m <br /> m <br /> ADDRESS /O O M O V AJ a ,f 3L (/ 17 �)p U C A41,) _C s/ 0 g <br /> EMERGENCY/FIRE NUMBER 2 Y9 O 7 ROADNAME U-)QST YN/� ..Pf �o(a <br /> LEGAL DESCRIPTION (see tax receipt) I <br /> I <br /> CONTRACTOR C� l� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARYPRIW FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> C. <br /> / r <br /> STRUCTURE/ADDITION USE: Cc a <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) T <br /> 0 o <br /> o M <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 of the following:(a) building to all lot lines,(b)building to center line of road,(c)building -q <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 M <br /> dated by the owner. 0 O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a N <br /> PLOT PLAN o a <br /> Lort Lf 'J � IZO <br /> Hc'r- 111 0 <br /> r� c C <br /> a <br /> �V0 <br /> YO311 <br /> —� <br /> jO <br /> 2J <br /> 3dL <br /> �--- S cu 6,✓ i y y 0 y <br /> w � <br /> ua � <br /> 66' ���p"z'/�y�� //A�Cr�, VC Pn41, bJ� 1/1 r�yW rPF� 1� M o c m m o a <br /> ✓'"'T tit" /��Fi/'F—d7L.. //'� ,�y� IAPL.I� Lo. M g� > 'n m a Imo <br /> NDITIONS OF PERMIT: � �s✓jy }'K r�- " $ m < 01 C u o S ic <br /> v Z 0 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAY PERMIT ISSUANCE._ o <br /> 2 REM OR CUTTING OF TREES AND V S�iESTRR.TEQ7SLDFG 'MORP_tttVE-"�"`� - - = t» M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m C <br /> $ c : <br /> n i <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 informs- <br /> lion contained in this application(including any accompanying schedule)and I further declare that I 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 Darmit. I $ m $ <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. N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O p, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 g <br /> m a n H <br /> M A <br /> 0 <br /> SIGN HERE _ <br /> (signature of o e r ing co r or) .(Qetal'' i r' <br /> 8 : x <br /> ZONING ADMINISTRATOR .l Z �- ' $ <br /> TO NSHIP PERMITS MAY BE REOUIRED J ; , <br /> �' G 1 9 199? <br /> pN pNN pON pO Op ,p m <br /> Ube <br /> I ly � SSS $ SSSS Vl <br />