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BOmett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator in o-' o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes o <br /> g by application for a Permit for the work described and � m <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 3 a <br /> regulations of the State of Wisconsin. �, m <br /> c <br /> c <br /> OWNER a O <br /> \CH Qi2� RNA K j%Sg- S aaR TELEPHONE C(ol L� y 2A <br /> r��,�� `,,Iw <br /> ADDRESS rA 1� IW VTI leaI a�P �(_Vv -5�I�.r' <br /> EMERGENCY/FIRE NUMBER ROAD NAME wv^r'3 HW`{ Pt <br /> L477f� ti C:2s � svavE 2 Ki%? Ol�`' oc>c :+E w- "?E53C -� <br /> LEGAL DESCRIPTION (seetezrec'eipt)BiLFc:2AE.� 2N <ct..:.-1� ty Cr lkim"! �t ac s,:, $c:. -F}']�iN -'wr' <br /> r kGc. br " . ,gr r <br /> CJpNTgqgqCTOR LOG[ V3Zr:u+$.�� W= ii <br /> CJ <br /> PkM i 1�..'.`c,':. _N �Ow:v r:is 3Rt+G b3 T.oa 3y t'�4w•��w.? yt; <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE C ADDITION p <br /> m <br /> n L <br /> SANITARY PRIVY CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: '�5t(j 1'-CLCA / "' a! / o ° <br /> (Home/Cabin;Cornfi4ercial Business; Bedroom;Deck;etc.) z <br /> o ° <br /> a <br /> m <br /> 3 <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). o <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 /> 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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 5 ut <br /> 11 Z c <br /> PLOT PLAN Scpv c yks T-T. A o n <br /> L_Cr a t tk LCT a ♦ CZ * ::�J- C i ° <br /> c.fib:1k <br /> t <br /> Ci <br /> I ° <br /> (1 I <br /> CfynX�c tTTk ti U'3F E+rrni <br /> a <br /> �- <br /> t <br /> J�'�t:, ( +o t)e H'i <br /> �rOM (,�rc�IwQ f7"t�� WA�'d>r�1Ntk V� Ns� I <br /> d y m r•:. � z <br /> a <br /> ? 1 <br /> m — <br /> U N L Rtt , o <br /> D t�rnv(nr DDt7y <br /> 7if,E > qtc —g '.o0 amm <br /> M <br /> = X! <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE, e m o_ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ _N <br /> 'R <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> LT 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «.y.n' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor B g p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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• rn <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i n N 0; <br /> access to the above described premises at any reasonable time for the purpose of inspection. °' m <br /> m ` v $g <br /> �] [ N <br /> SIGN HERE n �.� n o E <br /> (signatu fcaner o buYd' q contrec -- ----(date) <br /> / - € 8 : <br /> Flo <br /> € <br /> of <br /> ZONING ADMINISTRATOR C 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 ;`iI 'o Ln 0 g m <br /> 00000 $ 90M <br />