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memp. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Offloe of Zoning Administrator 0 m i o <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 p <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the � $ <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. w m <br /> 4 a^ <br /> / C <br /> OWNER �M d- KATHY (V VfS TELEPHONE f <br /> I <br /> ADDRESS 3991 - C-r / , Vv ylt7- CY6" <br /> EMERGENCY/FIRE NUMBER 38 <br /> o <br /> ROAD NAME OT y A <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) Lart,F e9m J, ( )f /a veoyr Lo T 283, sx 23-rif0A) <br /> CONTRACTOR t w N fad <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ao <br /> 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: 762cr-- A'T ars-0 PoTI o o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 0 <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 North (N). <br /> 2. Show the location of the well (yi),septic tank (ST), and drainfield (DF). o <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. f) <br /> NOTE: BUILDING/STRUCTURE LOCUTIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> c Z a <br /> PLOT PLAN OJe�. ��I a(� 6a3 o n <br /> C I = <br /> ot At <br /> � P/rroo G�CLr rf <br /> rn <br /> Z <br /> 0 <br /> _ <br /> o <br /> 3 r '- W <br /> G <br /> � m <br /> �u I� <br /> Z <br /> MM <br /> CONDITIONS OF PERMIT: FL� = o.a <br /> �3,: 2 c8 g's Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m ' ffi Z =j2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p _ ` �-,- 2 M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' In <br /> aEri <br /> E i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- a ! <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- i N a N: m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I 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 providing in this ap- i i ' <br /> plication.1 agree to rmit county offl harped with administering county ordinances or other authorized person to have o p <br /> access to the a eacribed s a any reasonable time for the purpose of inspection. <br /> 24o—/I N <br /> SIGN HERE <br /> (sign owneror Wilding contractor) (date) <br /> ZONING ADMIN TRATOR <br /> • NN+�NN N+ n <br /> TOWNSHIP PERMITS MAY BE REQUIREDg N N 8 N,N N 3 m <br /> 88888818'18 ami <br />