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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872Aw'�ro �n <br /> Office of Zoning Administrator N Z <br /> APPLICATION FOR — LAND USE — PERMITS E <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as Shown herein. The uees m o <br /> Burnett County Land Use Ordinance San�tialioon C that all work shall be done is accordance with the requirements s the m c <br /> regulations of the State of Wisconsin. COQ'and with all other applicable COurriy Ordinances and the laws and a <br /> OWNER c� g <br /> �14R S /7/9QOe/L TELEPHONE /4— - 63S7- 2 30 E <br /> ADDRESS 1 m <br /> ii / 6s' Sao° Ll a u,, <br /> EMERGENCY/FIRE NUMBER VU <br /> VL, ROAD NAME F-mG/T C k d L <br /> LEGAL DESCRIPTION (see tax receipt) S.t / i �l � <br /> E /st fe c 3 T �,v R ik uJ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGy <br /> GARAGE/ACCESSORV STRUCTURE ADDITION X <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING <br /> CAMPING UNIT SUBDIVISION ° O <br /> 0 <br /> STRUCTURE/ADDITION USE: 5 O0rt/ /�U.CC !'j ��/ I�r .� <br /> m � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) ° <br /> v <br /> Zo <br /> 0 v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I a <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 <br /> r mark of lake,stream, or river. <br /> 4. If separate t <br /> plans are submitted ent to the ordinary iby an agh rchitect engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITEISSUED.VERIFICATION BEFORE A PERMIT CAN BE O o <br /> PLOT PLAN 11 c m <br /> M z <br /> o n <br /> RAINQUtt) <br /> I&L III <br /> rA <br /> � s <br /> Ilk <br /> O IVV <br /> � R0ej1�to <br /> > +� I(' 1 <br /> Nwed <br /> CONDITIONS OF PERMIT: m 94 2.n �`€ RI <br /> 7. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN fi0 DAYS OF PERMIT ISSUANCE. z o is':` ? C8 g ; <br /> 2. REMOVAL OR CUTTING L TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f 0 : E � ' ' M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Z,": ` y- M <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- o O ' O <br /> . ` of C_ <br /> tion contabelief <br /> n ted in this applicationcorrect <br /> (including aany accompanyingthat I am responsible for the schedule)and I further declarerail that Idrecogn recognizeof thatall <br /> th this n oe- - M <br /> merlon 1 am Providing will Iss rolled uurnett ? $' S G <br /> further Accept all liability which may be a resultofthe County Burnette elyinig on n in thiseinforrmat on I am providing nwhether to issue a pth s iap- <br /> plicatlon.l <br /> agree to permit county officials charged with administeringcount ordinances or other authorized <br /> access to the above described Premises at any reasonable time for te purpose of Inspection. Person to have <br /> (e� <br /> SIGN HERE /V4.406.- <br /> /U —13-9Y <br /> /(tlgnaturof of owner or building contractor) <br /> ZONING ADMINISTRATOR Vlr)1r�/tini'�,,•t ' E <br /> TOWNSHIP PERMITS MAY BE REOUIRED Mn <br /> o vt $ $wt I�'i� <br /> 88888888 (Mi <br />