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Bums q Cou>sty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admini trator qnm o '�Z <br /> APPLICATION FOR — LAND USE — PERMITS E <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makesdescribedr °— <br /> g by application for a Permit for the work and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremerts of the o <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the I ws and C) <br /> regulations of the State of Wisconsin. o <br /> u m <br /> _ w <br /> c <br /> OWNERRazid <br /> ' <br /> I�rl! IOC TELEPHONE E <br /> ��/ l) O r <br /> ADDRESS L13qS S Was e/� Z u / l�iS y m <br /> f� r 4/ r 7 <br /> EMERGENCY/FIRE NUMBER I)5 L7() ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) V-�' / �I / L/ �"1 ) 3 a— <br /> CONTRACTOR�_I, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o <br /> STRUCTURE/ADDITION USE: J Ori G eh- Screw o s <br /> (Home/Cabin;Commercial Business, edroom;Deck;etc.) Z <br /> 0 d <br /> 0 <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 Nort (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (D17. <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 9 <br /> dated by the owner. O S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUS( BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v to <br /> Z c <br /> PLOT PLAN <br /> C�e�) C N <br /> ' <br /> !� w <br /> ly l <br /> c <br /> 9.� N <br /> 6� 0 <br /> g <br /> Qbt <br /> Pow <br /> o <br /> a& 4 Imo_ <br /> 'ti fly <br /> O <br /> Z <br /> do <br /> -3 55 <br /> r <br /> Mwd &oQvw Sxw 8' <br /> a��t'c1olJ- AAdel� rj i 1�� 1'fP'tEL— g 60r-j'FRa0m <br /> Woss• 2 11 <br /> CONDITIONS OF PERMIT:: X o Z C 8 g'S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIRE ENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 30E �Z : -� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f ' —N` i 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O i i ' rn <br /> Nfil L E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of m know]- J C <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all nforms- i « 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 parrnit. I g 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.Iagree t mid county officials charged with administering county ordinances or other authorized person to have <br /> access to the abov scribed premises at any reasonable time for the purpose of inspection. T <br /> m i <br /> SIGN HERE N <br /> (si at roof owne Ilding contractor) <br /> i S i <br /> ZONING ADMINISTRATOR <br /> «NT <br /> TOWNSHIP PERMITS MAY BE REQUIREDg o N N m <br /> $ $ $ $ $ 8 <br /> ° $ $ ai <br />