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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � '11 i z <br /> 0 f <br /> APPLICATION FOR — LAND USE — PERMITS m _ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m = <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 1 a La <br /> regulations of the State of Wisconsin. — o <br /> w m <br /> m <br /> OWNER TELEPHONE3I1 O <br /> t•1 Nle JC (TJ v JJJ O <br /> ADDRESS Z Jr'� p �4KCREST D12- DoBouE IB SILoo( <br /> - ' J <br /> EMERGENCY/FIRE NUMBER ROAD NAME24 <br /> " <br /> ` 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> u� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGElACCESSORY STRUCTURE ADDITION <br /> � / 0 <br /> SANITARY Y PRIVY FILLING/GRADINGCAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: d0X 3j /y4r_,41 <br /> o ' <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <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). CA <br /> 2. Show the location of the well (V ),septic tank (ST),and dralnfield (DF). 5 <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. C) T <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 'A <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c N <br /> PLOTErL <br /> PLAN 71 Z <br /> '1J C <br /> //Vql•� 07.33 �46vde" qra��- M i � <br /> fTOr{.5� >� /�'so�A'ron, Offl�%lI of rajfberry LaKJe 1 In <br /> DRi�� WGA meds t„��u.'rra� Cu il/ t Ak*aro II f /7krel,�n/S, <br /> y <br /> N <br /> U ' O <br /> ap <br /> O y <br /> N <br /> n <br /> Z <br /> 1 <br /> i; <br /> m Da� = my <br /> CONDITIONS OF PERMIT: °" <br /> v < z. : m aoo =0 <br /> M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c iu c ? o Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. — m <br /> 'mom : O <br /> DP (including Yaccompanying 1 g ` ' C <br /> I declare that this application mcludin an schedule has been examined by me and to the best of my knowl- � m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m <br /> mation I am providing will be relied u 8 : O <br /> P g upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $u 8 <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 n i <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> o no <br /> SIGN HERE <br /> (ilgrlatu of w r uild tractor) C ) a . <br /> C J i aE <br /> ZONING ADMINISTRATOR _,7 . j ? $ x i <br /> OWNSHIP PERMITS MAY BE REQUIRED _ 1� 1�='`= <br /> NN rnoo m <br /> LLMC' Ll- /L/ -4�'�' <br />