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(,ti 66)7Le- <br /> Burnett County 7410 Co. lid. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 mo 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3, <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m t <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <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. N m <br /> c 9 <br /> m O <br /> OWNER H0 e Pke56 tel-iaK C �14►'GLj TELEPHONE ,(Gia gG6_ 40,s-s <br /> ADDRESS 71S-3L Pd f'�9hd AVS (zIG� TIQ �i{. Mnl ss�fa3 <br /> EMERGENCY/FIRE NUMBER 'j 9 S 0 ROAD NAME Il Oa it <br /> LEGAL DESCRIPTION (see tax receipt) Lcit / Sec 1 -7 <br /> CONTRACTOR 14ape PVC bf epi4,, F6 <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE_C ADDITION o tri <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTUREADDITION USE: '2a+ iOI ��O / X4a ' $1 <br /> Co a CD <br /> (Home/Cabin;Commercial Busyness; Bedroom;Deck;etc.) z o <br /> o a <br /> 3 <br /> DIRECTIONS FOR PLOT PLA 14 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 ellse S <br /> (VV),septic tank ( T), and drainfield (DF). 0 <br /> �-. <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building q <br /> measurement to the ordinary high water mark of lake, stream, or river. Q <br /> 4. If separate plans are subm fled by an architect,engineer,builder,contractor,etc.,the plans must be signed and � � <br /> dated by the owner. o <br /> NOTEBUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> PLOT PLAN NI. MKIk 4th °4 °� n <br /> N <br /> 75� C o <br /> J M _1 <br /> ° NQ <br /> 1101 , <br /> u It N <br /> it <br /> If <br /> \ ( f <br /> r <br /> Mf4d Nei) _ <br /> Lake <br /> 100 <br /> a a * m <br /> m ELI 2. 0 - <br /> n y <br /> CONDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST MEET RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Q <br /> f <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> in; <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'No m <br /> € Sri <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,coir ct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- »y a m <br /> tion contained in this applicat on(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. I o`8 0 <br /> further accept all liability whi h may be a result of the County of Burnett relying on this information I am providing in this ap. N <br /> plication. I agree to permit co my officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above describedpremises at any reasonable time for the purpose of inspection. n 3 0 <br /> A N <br /> �,/� <br /> SIGN HEREE <br /> ( i to of own r building contractor) U f (date) <br /> o : <br /> ZONING ADMINISTRATOR 8 ' <br /> -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u, m <br /> I''- o o o o o o 0 o ycn <br />