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0/1 �07L�), <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> 5 0 >E <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 v m <br /> located as shown herein. The undersigned agrees that all work shell 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 _ <br /> regulations of the State of Wisconsin. u m <br /> OWNER EA 9 Y "r 57R(1 L) £ <br /> TELEPHONE -715— G�.� g' �A' <br /> ADDRESS 11411 Nw rh �}� ��Ln �RIV� VRf1� 1SQUQG l�c� m <br /> � r <br /> EMERGENCY/FIRE NUMBER I l / ROAD NAME L <br /> LEGAL DESCRIPTION (seetaxreceipt) f S <br /> EV <br /> , E DIV. O'F LIVJ <br /> CONTRACTOR W4 Nt, LANG 3dN IS )IvwP OT Wood Riot?, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING I-" GARAGE/ACCESSORY STRUCTURE ADDITION o / <br /> n L) V <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> J <br /> P�kMAN�• lll� f�a � m <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> O p <br /> R <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 Nort i (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 1A r <br /> measurement to the ordinary high water mark of lake,stream,or river. J <br /> 4. it separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all,ned and <br /> dated by the owner. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 1A a <n <br /> ' 1 z c <br /> PLOT PLAN ��._ �`9L1 o n <br /> m <br /> sed <br /> Po 69 <br /> S <br /> . �toSs�c re <br /> O <br /> O <br /> O <br /> m <br /> O � <br /> N <br /> CG �l1 <br /> Z <br /> n <br /> n I`" <br /> m D D m <br /> CONDITIONS OF PERMIT: <,z': Q C 8 8 o IC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m 'Z ; : 4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P E y' i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- �` o : 0 i <br /> C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- N m•" T <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize the this infor- G al p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 C ; ; 81 $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providinj in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pen on to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. r <br /> SIGN HERE - ' $ <br /> m <br /> N: <br /> (signature 91 owneror building contractor) ) (date) <br /> ZONING ADMINISTRATOR <br /> ISI MNM+MM Mf�1T <br /> TOWNSHIP PERMITS MAY BE REQUIRED SEP 2 7 —' III, o N >S f i� NIE51m <br /> L_ _ <br />