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04 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, III 54872 Office of Zoning Administrator 0 o O' o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The here undersigned g by makes application for a Permit for the work described and <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 Cade,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m <br /> /� .,y� /.� /� 6 / Z - 220 - 1221 ,[/.r1ORK " m . . <br /> OWNER' Ild/�t/7.� t/j. � R O(� �, �UO/Qti. TELEPHONE6/ 2. `S /,1`tXJ.3O /70MC p � O <br /> ADDRESS Ce-Af7iQlt(, AVE, IUts FA I DCEY 14AJ 55'43 2- <br /> EMERGENCY/FIRE NUMBER ROAD NAMEOT <br /> N <br /> LEGAL DESCRIPTION (see ttaax ,,p,e ✓ifpgo GL4 S wW �S2p�T37N R18W `� �' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE__— ADDITION p �' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTUREADDITION USE: CnjleAC . o <br /> CSEfT <br /> (Home/C— w <br /> ^ <br /> usiness;Bedroom;Deck;etc.) = o r <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 draiMield (DF). I 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o va <br /> PLOT PLAN o n <br /> pLEfA_SE sty tFT)Acc2l Petr MAP siyercyf 111111 0 <br /> �Sfjow, AJCv PRoPo5ED ttocAz7oA1 dF STo>QA-GE SNS i — <br /> nl <br /> _ <br /> 0 <br /> _ <br /> m <br /> v � <br /> N ,1 <br /> n <br /> i <br /> Z <br /> S <br /> Rgo_Lh-0 L*r-Dgf m <br /> m 9g� �aa 0. � <br /> CONDITIONS OF PERMIT: = < w : z g 14 g U i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F i Q ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �rgn XI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O1 i O O <br /> 5 € <br /> g' e ' C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- (�' o : !E <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- `: «a« m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- 8 B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I . 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing In this ap- E i ' <br /> plication.1 agree to permit county official"charged with administering county ordinances or other authorized person to have m: m <br /> access to the above described premises at any reasonable t!Tq for the pu of inspection. <br /> M1�7— <br /> $ ` <br /> m ' <br /> SIGN HER <br /> (sign" of owner uil ng contractor) <br /> `r' ✓� i ' o i i <br /> ZONING ADMINISTRATOR <br /> ��L �' ----�i��' l` ` 8 ` 3 <br /> TOWNSHIP PERMITS MAY BE REOUIR n (PERMITS MAY BE RECUIR n « a In <br /> b $ $ $8N gm <br /> JUN 8 ' �, a N g U) <br />