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CYL &W�P , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> J <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q O O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 co <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ ^ <br /> o <br /> regulations of the State of Wisconsin. �, m <br /> N <br /> C <br /> m Q <br /> OWNERkU� TELEPHONE '`f� - p $ '9 <br /> ADDRESS N\\y e- U% A`�� e-M 00kS' M/V <br /> EMERGENCY/FIRE NUMBER "1 [. n .� ROAD NAME <br /> p 1. <br /> LEGAL DESCRIPTION (see tax receipt) ?6 V-` b( G , C)(,�`•�1 q(� 13`I (✓ N4� (D <br /> CONTRACTOR �'L `'K Sa a G ,y wjl' n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION._ v <br /> n Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: `, <br /> Rbe•1\IIU,,; io X�sT St Yu�lury LR.S6t�w \<kUlkv o <br /> ome/Cab ,Commercial Business;Bedroom;Deck;etc.) `. - R1' uz Z <br /> o ° <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). g <br /> 3. Show dimensions infeet of thefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building -1 <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 9 <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 N <br /> 71 Z o <br /> PLOT PLAN 1(z 54 N1'lCy SyiZ e W., - eu rJ�'O l.i o a <br /> Ino <br /> ILX( 5* DcLIl, I �� D <br /> 1 <br /> Zc..>t 1!j <br /> 32 Cabin/ :V <br /> fl f; <br /> Kzw, 4ddiitlon� o <br /> i'1fi r\44 f <br /> 71 <br /> z. <br /> Z <br /> l � <br /> wt1.H riP1Se <br /> C r 0 a v e <br /> 2. Qm <br /> CONDITIONS OF PERMIT: < m': Q c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. M ! ' 62 :: m <br /> of i alp ° 6 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : ^: m i C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- fw m rA; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a g p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o <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 Q N v <br /> access to the above described pr ises at any reasonable time for the purpose of inspection. 3 0 0c <br /> m p <br /> 8 : <br /> o <br /> SIGN HERE <br /> (signa a own r r building contractor) '' <br /> o <br /> ZONING ADMINISTRATOR '. 8 <br /> / t^.i - i fn fe»Z' to en fnT <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� o UNI N N N Vn 6 m <br /> � i <br /> 000000oom <br /> 00000000 In <br />