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on corn, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54672 Office of Zoning Administrator m m ; c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall 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. w m <br /> OWNER I / /7 /• / [ •rtf� �[ln £ <br /> /l TELEPHONE / q/ <br /> �t/67a/t � , (//�a1 a h G y^D ��� <br /> ADDRESS3/ G✓ I� Sfi .—_nyer �oV, I I .5,J(J <br /> EMERGENCY/FIRE NUMBER 7 �!/ ROAD NAME y)N,:✓e ',I 1 ___0VVV <br /> O ) oser !l <br /> LEGAL DESCRIPTION (see tax receipt) <br /> /a/C-/y1 ` X /ryU/� �`sw 'fcrc5 '?, <br /> p6/ >b.yro/a fAd 3And If /!ZM v% -a <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 0 <br /> SANITARY__ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 ° <br /> STRUCTURE/ADDITION USE; <br /> (Home/Cabin;CYmmercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> m <br /> a <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 drainfleld (OF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to carrier 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 be signed and X "1 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 'tl 3 y <br /> PLOT PLAN o n �. <br /> N <br /> 1` C I <br /> 11 <br /> '- �' <br /> El <br /> o' <br /> N <br /> Z <br /> 2 flo4s� ': 3 <br /> I To be A <br /> t to F+ aoo' Ya 44 n <br /> 1a1ti NG'f 7v S"t'r g �'Ln� 'F t� m <br /> 10 CONDITIONS OF PERMIT: �' o g.. Q V's g E. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a'i Q —1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 21 rn i i 33 <br /> PERMITTED. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERM <br /> € �' S In <br /> Ei c <br /> PP (including Yaccompanying 1 Y Y p i <br /> 1 declare that lois application includin an schedule has been examined b me and to the best of m knowl• : 4: <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 r In <br /> tion contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. f 8 B <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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• d, <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. <br /> M i '2A 1i <br /> g : <br /> m <br /> SIGN HERE <br /> (SlIrlfl ure of o r or building contractor) its I E E E <br /> ZONING ADMINISTRATOR ` 8: E <br /> TOWNSHIP PERMITS MAY BE REOUIRED JR31994 N95fii a9""Jui mmM <br /> _- ---"' 8 $$$$ 8$ 8rn <br />