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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator cn r 1 o 0 <br /> APPLICATION FOR - LAND USE - PERMITS �_ > <br /> TO THE ZONING�ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'Z w <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 3 <br /> regulations of the State of Wisconsin. — <br /> 0 <br /> OWNER �dCf1 Sf1Cl_1`�f�l J1ill t'�SC%r'} TELEPHONE553 � o. f <br /> /'' r I _/ <br /> ADDRESS /J�3 0hewla � l-I J�IX�Oli1l1 1�'- 9G'&– :T —C- m <br /> EMERGENCY/FIRE NUMBER3 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) i <br /> CONTRACTOR I he If <br /> TYPE OF PERMIT(S): DWELLING/BUILDING �-l• GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> . I c ,�lJ ( /1 i �1 � 1 <br /> STRUCTURE/ADDITION USE: � J�(P_Scr \ 1 Cy k ( d,� i!1 (x (SCS di o o = <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z a <br /> o <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). S <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions infeet of thefollowing:(a) building to all lot lines,(b)buildingto 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 IN ,J <br /> dated by the owner. o <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an m <br /> PLOT PLAN Z Q <br /> SEE VARIANCE 11478 � o 0 <br /> M o <br /> C <br /> M � <br /> U' <br /> 1 - <br /> _ m <br /> 1 <br /> I s L W <br /> tv <br /> f <br /> y1) $ zo <br /> I <br /> r ` <br /> r <br /> _i <br /> 2am g+m m <br /> CONDITIONS OF PERMIT: c m N;: Q CS =�' E <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m' o s Z - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F oN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N L1 2 m <br /> of �� ; O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o' m R= 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 y a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �9 a o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g`$ 00 '. <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 premises at any reasonable time for the purpose of inspection. Z5 R- <br /> CD " A <br /> F 00 <br /> SIGN HERE <br /> (sign of o r building contractor) '---(date) E rN <br /> ZONING ADMINISTRATOR "t- � � - - - <br /> E <br /> MHH�+d1 d1MW T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N N N N m <br /> M <br /> 0006 O O C <br /> 0000 $ 0, 000 () <br />