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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 'cn m o J o <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 m Cc <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. N n <br /> 4 <br /> OWNER IJLy� TELEPHONE e2j'S-, O J9 r d3 + _0 <br /> 1 a f <br /> ADDRESS /5110 SuAmLic LNr' VRV C-0'W .LF [V( 5-Y703 " t <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) ,TN NgV(.Art�Jr w i <br /> CONTRACTOR Jv(C.(Cy PjI VVLV% 'evit ,B�.. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING — GARAGE/ACCESSORY STRUCTURE ADDITION p �' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: 6417 ° <br /> u r <br /> 1-a.�/ L/ <br /> CA,MjV 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z � <br /> o ° <br /> a <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). <br /> 2. Show the location of the well (W), septic tank (ST),and dreinfield (DF). � <br /> 3. Show dimensions in feet 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 <br /> dated by the owner. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o m <br /> PLOT PLAo17 <br /> n <br /> Qo m <br /> 5` 1°/ 01 <br /> en <br /> N y` <br /> tom' O IrV,\T'1 <br /> J <br /> J <br /> N <br /> M � <br /> Sot s�di/b zpt <br /> /x/28 x zI <br /> 3Df 3 s©em FUTV. - Wt (r I y <br /> (v. <br /> M QE1 SePfl� lT701X1 <br /> ANIC. 3114 SCAL1 -I r� <br /> DPAWFI" 10 <br /> n J <br /> CONDITIONS OF PERMI �CAp <_m ' Z m o 5 ' <br /> . m <br /> 1. DRIVEWAY MUST MEET RIVEWA WIDTH REQUIREMENTS WITHIN 60 DA OF PERMIT ISSUANCE. o E 0 T•z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = »� <br /> 3. NO GRADING OR SHORELAND ALTERATI Njif ARE AILOW D U SS SPECIFICA V PERMITTED. G) n <br /> g n <br /> I declare that this h JAI din dule) r�rnine � my knowl- S : ' `° `� ' M <br /> edge and belief c r and I e. ac n wledge t at I res tole for t e ra II informs- '" e` 0 Q' : <br /> 0 <br /> lion contained i ap is i cluding ny compan hedule)and I further clare that I recognize that this infor- �,° <br /> mation I am pr i on �cppnsin i ing whether to issue a permit. I i i 8 a $ <br /> further accept at li ich be a result o the Cou t o rnett rglying o t i tion I am providing in this a w <br /> plication. I agree to permit county officials charged with administering county or nces or other authorized person to have , O cNn p <br /> access to the above cribed premises a y reasonable time for the purpose of inspection. 01 8 9 <br /> In A x <br /> SIGN HERE <br /> N : : <br /> (sign re ol owner orbu'dg c <br /> ZONING ADMINISTRATOR <br /> ww w <br /> TOWNSHIP RMITS MAY BE REQUIRED AUG _ 7 1992 10 <br /> u, .0 o .8 <br /> 188 88 8 <br /> I <br /> I <br />