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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SUn Offke of Zoning Administrator m 0 O <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m o J <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremems of the '0 $ <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. m v <br /> a g <br /> 11 m o <br /> OWNER M)Grt AI=L E- N0 =- 0r7 1 L TELEPHONE "� � G� _(.P3�_-��, (7 ' <br /> ADDRESS 2-0-:!A4GO- TzP A ;J POO f�1�IZ F \"a l <br /> EMERGENCY/FIRE NUMBER 203>4 <br /> 03>/1 ROAD NAME L, - p A , - <br /> LEGAL DESCRIPTION (see tax rece;pt) -5.(u t o o f -T+-4E Is-. Sao' ) SE-S W t 17 F-c. t S -4c + 14• <br /> IT <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE. X ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° l." <br /> 'aJ J (� o <br /> �V�I N�(7� I Ji Nlrv� I X�^(O(N*I Add l.1 f C, " 'j__ <br /> _ �c4, _ o 0 <br /> STRUCTURE/ADDITION USE: i L C*.�I � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) / z o r <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and ail new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank(ST),and draintteld (DF). <br /> 3. Show dimensions In feet of thefollowing:(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 sl ned <br /> dated by the owner. I 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 4SUED. 7I o m <br /> PLOT PLAN 1] Z c� <br /> (^ o 0 <br /> In <br /> Z� <br /> li i u, <br /> o <br /> '.L 1 <br /> yk C <br /> Z <br /> F <br /> I <br /> - - 06 <br /> �. $ <br /> S� am £ <br /> 0 <br /> D - � m <br /> CONDITIONS OF PERMIT: <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <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. .I Ti ' O 2 i m <br /> 10 <br /> y_r: Qg € <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- ora <br /> wipe and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of ill informs- a �^ m <br /> lion contained in this application(including any accompanying schedule)and I furtherhe declare that I recognize tthis infor- <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized per on to have i O , 0; <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> C <br /> SIGN HERE J� E s" 3 <br /> (signature of owner or building contractor) (date) ! ': <br /> ZONING ADMINISTRATOR r - <br /> w' a <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` "o 4�E iD f5 m <br /> $ 8888`8,88 rmn <br />