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e7i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admin strator m o c c <br /> APPLICATION FOR — LAND USE — PERMITS _ >< <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr bed and � a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremet its of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the I aws and <br /> regulations of the Stale of Wisconsin. N o <br /> r74 <br /> lY1q�y J. , Me It ;so K , ra <br /> OWNER S TELEPHONE C £ <br /> t 5- 885- 3 <br /> ADDRESS h AV C en ke <br /> Vim* —C <br /> J <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> V <br /> LUT I 1p L K a E FFft CS ' ; <br /> LEGAL DESCRIPTION (see tax receipt)S. <br /> J vc, r <br /> CONTRACTOR <br /> y1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o 1 <br /> SANITARY PRIVYO <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> i p <br /> N <br /> `��'' r <br /> STRUCTURE/ADDITION USE: W `-73I4 _ <br /> (Home/Cabin;Commercial Business; droom; Deck;etc.) Z <br /> o ° I <br /> } m <br /> a <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 i (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 1 r <br /> 0 <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 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I v rn <br /> PLOT PLAN Z $ <br /> � d o <br /> J) <br /> I , <br /> Ui3 LI C L L r - <br /> . 'reg <br /> or <br /> i p cH83a 0U <br /> 171alltLTN6�ltI/S � <br /> 'A01, y• ST <br /> y ,pF „ '0 <br /> f <br /> IE/G'j! <br /> !a11 m <br /> CONDITIONS OF PERMIT: <br /> m': ZC8 g' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIREME (THIN 60 D F PERMIT ISSUANCE. o 5 .vi —4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RES IC� p G ELINE. — <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNL f�.ALL MITTED. S i rn i ? O�, p O <br /> I declare that this application(including any accompanying schedule)has been exami me and to eat f cnowk, r.: o' : E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the and accure forma'��. F «+m a E m <br /> tion contained in this application(including any accompanying schedule)and I further declare th ognize t at his infor-I t f �' S rn <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining who <br /> is i permit. I j g°� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am p g n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authori rat n to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. i <br /> m i i <br /> SIGN HERE <br /> (si at 1 0 or building contractor) <br /> ZONING ADMINISTRATOR E $ i <br /> • N+�NM My 1t <br /> TOWNSHIP PERMITS MAY BE REQUIRED i 8 m <br /> Lj 888888 U) <br />