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`Jn- �rnP <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u m c c <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 � w <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 n <br /> regulations of the State of Wisconsin. �, m <br /> w � <br /> c <br /> /� ` m <br /> OWNER l Ai po l D.y TELEPHONE •'1`S'�0.35- �I9�lo O r n m <br /> ADDRESS ` !r" L��� / -� <br /> f \ <br /> EMERGENCY/FIRE NUMBER ROAD NAME / ,,,9A� J IV <br /> t 1 v <br /> LEGAL DESCRIPTION (see tax receipt) + - . S£cT� "'1""s�7N R/!f Lf/ (� d <br /> CONTRACTOR 7bwNoY RUS)C V' 0 <br /> _ � N oE <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> - I <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> m r <br /> STRUCTURE/ADDITION USE: .STo214 rC2 IC <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) z m <br /> c o <br /> 0 <br /> m <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). r <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 9 _ <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> an z v <br /> PLOT PLAN <br /> I j M <br /> v 0 o <br /> qo � <br /> � o _ <br /> 1 = <br /> ( � W <br /> F a <br /> r t 1 <br /> lb <br /> z <br /> 1 }� 14� N gfpanlC 75fr <br /> r>a Fm _ � a rn <br /> 533C y c = <br /> CONDITIONS OF PERMIT: m 0 <br /> �1 <br /> : Z W g .0.0051. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 5 TZ -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> H_ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. � o � O n O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- Lu o 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 informs- a M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 nit o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 6018 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 0" o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 'oo <br /> m A N <br /> SIGN HERE `-�' x- � <br /> H: <br /> (sf at a of owno 'Idfng contractor) (date) I, ': E }, <br /> o ; <br /> ZONING ADMINISTRATOR 'r✓ `-Z AUG - 9 `,., 3 i' g , <br /> i <br /> TOWNSHIP PERMITS MAY BE REOUI o N N m <br /> o '0000Soottoo <br />