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Burnett'County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS '- £ <br /> d = <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the S..�'1 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and n 5S <br /> regulations of the State of Wisconsin. ^al-5 7,7716? 7 y m <br /> w m <br /> / /A/� C /f''� y��+ Q �y7 /J c <br /> OWNERAA/ <br /> IT C.%C CjRK�' m <br /> TELEPHONE �J n £ <br /> ,,,� m' <br /> ADDRESS _ S 2S /� , 9 �CY `7 v �1 <br /> EMERGENCY/FIRE NUMBER SU j <br /> 6 S© / ROAD NAME O vis OAJ / C O. <br /> LEGAL DESCRIPTION (see tax receipt) �!/ !i <br /> CONTRACTOR <br /> 10A`4566 <br /> 0 A` C /' /' ���Cn t/ -/•4u <br /> TYPE OF PERMIT(S)):: DWELLUNCG///BtUIILDING JGARAGE/ACCESSORY STRUCTURE ADDITION p / <br /> 0 Q <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: cAI eG — ' PJ � a o <br /> �. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> 0 c <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 y <br /> PLOT PLAN Loper (7 Q— nf7T a.. Coh$i e/e ec. o S <br /> C�w l�� 10 s r mcr�s•A m GQ y <br /> i v C) <br /> g> <br /> c51 <br /> I <br /> _a <br /> N <br /> O <br /> _ <br /> 0 <br /> rj <br /> D ^ I p <br /> z <br /> I, <br /> A4 CkpIN Q swk r- <br /> 3,."well <br /> OSerf.�TA^K <br /> Mo � � dma' aa v <br /> m <br /> . v �� 0 <br /> CONDITIONS OF PERMIT: o m < C w l o ; <br /> 1. DRIVEWAY MUST MEET DRIVEWA OUIREMENTS WI IN 60 AYS OF PERMIT ISSUANCE. o £ ? � 'f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ »� : m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. t7 2 O <br /> g nC C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of myknowl I o_ : A '� I 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- w m D <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <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 00ministering county ordinances or other authorized person to have <br /> access to the above described premises a y r n time for the purpose of inspection. 3 8 3 <br /> n V A w <br /> w m A <br /> SIGN <br /> (sig ur of owne uilding contractor) (dale) <br /> . ? : <br /> ZONING ADMINISTRATOR <br /> H <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 01 J N w 8 9 m <br /> N N N $'O N O O , m <br /> $ $ $ $ $ $ $ $ tmn <br />