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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn 71 L4 z <br /> m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby by makes application for a Permit for the work described and Z m <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 3 0. <br /> regulations of the State of Wisconsin. <br /> (� 0 <br /> OWNER W/ //,� J P.4 rSOh TELEPHONEn m O <br /> 612 f <br /> ADDRESS /�T. (Q BaX 3I(o¢cl RUM River J)r. (,4wm".e' /11/V S.SOD� I m <br /> EMERGENCY/FIRE NUMBER 4 '.7$37 ROAD NAME [44 <br /> LEGAL DESCRIPTION (see tax receipt) LO f 17 Cleat- S/l 4cres ""` ."f'1 dIZ -9100 —OZ-B'00 <br /> CONTRACTOR Self <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE, ADDITION O C1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 0 <br /> o < <br /> STRUCTURE/ADDITION USE: Sixuha o 0 Qj <br /> o YVJ <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> ldings (NB) and Indicate North (N). <br /> 1. Show the location and size of all existing buildings (EB) and all new bui <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of thefollowing:(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 b, signed and <br /> dated by the owner. <br /> NOTE: BUILDING/ST UCTURE LOCATIO S MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN 0 CAN BE ISSUED. � o y <br /> PLOT PLAN ROAD Crna) <br /> ala -lacel f 7 SeQc c <br /> 9 P '" <br /> }'c / fh K�'15' r <br /> ro l-.Situ/{Q— �1�7�,`J+�S'e 2c <br /> - I FX1�/y �teQ &AFX Oukr l9eel� M <br /> 834 o <br /> IJ I V� . <br /> 28' m <br /> n_ <br /> o <br /> W irJ .2(o t 5T D F� N <br /> C/ o �O <br /> I <br /> 45— <br /> W Deck e O <br /> I Sauna 8" m i <br /> Z T 141 <br /> Ir qy.. <br /> IeIh 1 L I pkQ- 0 prC Nr DDp <br /> m ` 2`� a 'am aF� D <br /> CONDITIONS OF PERMIT: — <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? loo ? 3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - D <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i �a I O <br /> c E C <br /> g ' a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- � o � ' a <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 w : O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor .`b' SNi, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 8 <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> 3A � <br /> SIGN HERE ` <br /> (signature ne buildin n[ractor) <br /> ZONING ADMINISTRATOR g <br /> WNSHIP PERMITS MAY BE REOUI 00 .' o m <br /> JUL 24 Igg� 8 $ 9 9 ) <br />