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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and N '� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> L•T.TRnTr CA,14osr <br /> a,� / m Q <br /> OWNER 7-lf-r{OIV 1116-�A) L/FE F� T,E TELEPHONE <br /> p m m <br /> ADDRESS PX' / 2 Q 30 m <br /> EMERGENCY/FIRE NUMBER G�O C� ROAD NAME Ay <br /> zz /�S'� P <br /> LEGAL DESCRIPTION (seetaxreeceipt)Ffk NrV�� 44 Sc-3o 7 541 Hoer# )e 1( It) BKRA/G� <br /> CONTRACTOR 9/� /r1Zar2 o&P y <br /> TYPE OF PERMIT(S): DWEL///LING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: 5j-,0&4E 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(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. Q <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a ur <br /> PLOT PLAN N Z o- <br /> o 0 <br /> T m N <br /> g7.'5r'h4& 77 060Q= C <br /> Dlt?RI1'+f F t stD I <br /> W m <br /> w Z <br /> SePti� (L --d E� <br /> I <br /> —3 <br /> Pplf' � <br /> �sN 0 <br /> 0qg0 <br /> zz� 5TOWS <br /> I <br /> I Luoop /��Pk Rai 1 r H <br /> L <br /> z <br /> t ra <br /> L4 Z� Iz` <br /> LSO)-rod <br /> I Z oeP10�TEron� <br /> -Fee s7v�E' <br /> OSP b�RN TYP <br /> 3v' � <br /> Smf mv �w��nr-nDoy <br /> c 00g4 o- m <br /> CONDITIONS OF PERMIT: m Q as <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c 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. o G) <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.I acknowledge that I am responsible for the detail and accuracy of all informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- V a g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o <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 O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 'oo m <br /> v <br /> m m 'o : <br /> M N <br /> 0 : <br /> SIGN HERE-- Hill <br /> (sip to a of owner building contractor) D a� —'' I i : : : 8i i <br /> ZONING ADMINISTRATOR n g <br /> v.w -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED L) o d m <br /> 000000 $ $ m <br /> Vi <br />