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OQ ctolp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and N <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 3 n <br /> regulations of the State of Wisconsin. H m <br /> m � <br /> h <br /> OWNER J r~ O l�'E rYJJLJ � I C -1/ t'I /J L Y,L� TELEPHONE (P J t'I <br /> ° <br /> I/ j� n 'p-�� m m <br /> ADDRESS -j/�7,� �`/ ' L.t S L,C ��1� /DRNA bi-r J`111�.LJ 0 V� <br /> EMERGENCY/FIRE NUMBER 3�,� 7 ROAD NAME J''A P L L <br /> LEGAL DESCRIPTION (see tax receipt) mGrT� <br /> t" <br /> CONTRACTOR / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> `��-1 lL-I O <br /> STRUCTURE/ADDITION USE: � G(�C-(--�-` .V /"ON 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> o ° <br /> 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 infeet of thefollowing:(a) building to all lot lines,(b)buildingto 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 STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 a rn <br /> 71 Z <br /> PLOT PLAN P g <br /> m <br /> V- Lq Alan <br /> cvri <br /> I�IZl7(�D 9t_//> SG121a.trN �012�.1$ ( � <br /> ,6. <br /> 0 <br /> F(ISTIv 7s rIISSUANCE , <br /> o <br /> Nome o� ff 2.' of m <br /> .CONDITIONS OF PERMIT: a � y.1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENS WITHIN DAYS OF PERMIT . e o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �: t7 m <br /> o : a o <br /> € m c <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- a y a m <br /> tion 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 permit. 0`$ <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 n p <br /> access to the above described premises at any reaso le time for the purpose of inspection. 3 o yc <br /> c aD <br /> SIGN HERE Q.-[-c, ; . . .,GLsC 7 �3 L� 9-3 os [ <br /> (signature o o er r ildi Irac(ofi date) 0 <br /> o , s: [ <br /> ZONING ADMINISTRATOR J ' 0 E E <br /> �. <br /> N N J N N N V T <br /> mWNSHIP PERMITS MAY BE REQUIRED O N en N p CA00000000 <br />