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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872v, ( a r� <br /> Office of Zoning Administrator m o o z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here m ' <br /> makes application for Permit for the wrk described s <br /> located as shown heroin. The undo W <br /> undersigned agrees that all work shall be done in accordance <br /> dance with the requirements of thhee m c <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 Wisconsin. tS <br /> 'o <br /> OWNER <br /> TELEPHONE I _ rfS--S pAe <br /> 09 n O <br /> � F <br /> ADDRESS 73OS ala l_j SSD-76 <br /> m �1 <br /> EMERGENCY/FIRE NUMBER2 9 <br /> 3 .7 ROAD NAME )U � <br /> LEGAL DESCRIPTION (see tax rec1 <br /> )'-13 4a41Ja Sa J <br /> eipt) 1 4o`Q)(rW DGL'W 40(61200- 6-D <br /> D" MJAG DYV <br /> CONTRACTOR <br /> r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION /-9970 <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING J <br /> /i p CAMPING UNIT SUBDIVISION o ��� <br /> STRUCTUREIADDITION USE: CAQ)rv— 4-no r� r /� 7u ' - �' <br /> �V•11fRC /•7` 0 r- <br /> �. i?S o 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v !1 <br /> Z o L <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 a <br /> 1. Show the location and size Of all existing buildings (EB) and all new buildings (NB) and Indicate Nortl (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet ofthe followin g O g <br /> g:(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 sig ed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE LIED. 0 0 <br /> PLOT PLAN � c m <br /> Z 0 <br /> In <br /> c <br /> Li NokTH LlivIF IMII s <br /> iY u <br /> � J o. <br /> ryr ?tr1 A Chd -I <br />� gtly ►q7�0 F <br />/ O y <br /> � � S uTN I_tN6 <br /> CONDITIONS OF PER ��j\. a�.* 3 n A A e m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAY PERMIT ISSUANCE. Z m " ? �Z g� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. kj' Ng f ; fn <br /> I declare that this application(includingan accompanyingschedule has been examined by me and to the best of my nowt- 0 - - C <br /> Y 1 E 5:` <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all in rma- - t xa 53 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- v F v $ Is <br /> $ m <br /> mat er I accept <br /> providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a pe it. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing int is ap• ` g 8 <br /> plication.I agree to permit county officials harged with administeringcount ordinances or other authorized <br /> access to the above scribed premises any reasonable time for te purpose of inspection. person t have 0i oQ ; <br /> '} <br /> SIGN HERE � _... 7. o-. ...LS�,-- <br /> ignature of owner or building contractor) (date) <br /> m <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIREL59 <br /> MAY 5 '�J N 89;§95 NN p <br /> .._____ 88888888w <br />