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6�1a)�/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w m E z <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 <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 W1 <br /> ipconsi w <br /> c m <br /> Car i'�Ir � <br /> OWNER TELEPHONE L..� £ <br /> ADDRESS 12 y Sf [_GUAR P r L A-. u <br /> EMERGENCY/FIRE NUMBER Z 2 ROAD NAME Gfpp0/GrZ_ P r <br /> 7'�Z cA <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Al F S .&IL- 15 V<? TI Q/f! <br /> TYPE OF PERMIT(S): DWELLING/BUILDING/� GARAGE/ACCESSORY STRUCTURE M ADDITION p __ <br /> T n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v V' <br /> o ° <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 (VV),septic tank (ST),and drainfield (DIF). 0 <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. 0 <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE WED. 1I o rn <br /> PLOT PLAN I� TF Ee-e ur c2v o a <br /> �✓ �✓ M °. <br /> L /9 1-`- c I <br /> -30-K0 kc-eu;r s.+. 0&4&-Por in Z <br /> yo' � <br /> 24r �� I4 ° V <br /> 1 F'EGD <br /> 3 2'• s <br /> N <br /> Z <br /> Put <br /> l CWAIT�°'-- oS PW/A <br /> _,�t-a,� b¢+�vtenr N-uune r�-e.� �cx�ep>lron/ �o. Si*•:.Q.l oPeA•� dor (Cod <br /> a NS►xu� 6)� �+I+Gr .rte icx 6e 344m &fY t` exca�uir,v Aa6 p.ae �)�l-a r� r� <br /> D O, Oi D O 1J <br /> RRi bur saed&4 � /nw1r h p.�#-er eKt�v4fiav A. $� 2.am & m <br /> NDITIONS OF PERMIT: Z C g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN GO DAYS OF PERMIT ISSUANCE. o f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - .4Y�' O mO <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- •+m `^ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion 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- <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 promises at any reasonable time for the purpose of inspection. <br /> m e . <br /> SIGN MERE <br /> (sig roof owner r ullding contractoQ (date) pp <br /> i 9 E i f i <br /> ZONING ADMINISTRATOR ' S <br /> N N N N T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o m m b u m N'`o m <br /> $ $ $ 8888$ ami <br />