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N ov 7 N, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v m c o <br /> APPLICATION FOR — LAND USE — PERMITS ' 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and _ '- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. o <br /> w m <br /> w � <br /> OWNER /V+, tS' t TELEPHONE MG ry y� v O <br /> ADDRESS bq ly U Cr S St 0 0;1V <br /> 1 Vn TDSII � I � <br /> EMERGENCY/FIRE NUMBER2 W5 2$ ROAD NAME ,1 n LK R -� (y <br /> Joh S S jl,&Jal L404 +) <br /> LEGAL DESCRIPTION (see tax receipt) '� pp C <br /> CONTRACTOR P�oC l p ej� 4kfvl y(e o °L�4 °L �QYlCarY (JI S'I$30 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> 7`7_ <br /> 1pp � Ap 9191" <br /> �1 w r <br /> STRUCTURE/ADDITION USE: gnt_e01A LR to ltnnrne�M iiA 11EW 9191" o <br /> (Home/Cabin;Commercial Business; B droom; Deck;etc.) I <br /> oo <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) D <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)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 ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 o y <br /> PLOT PLAN z <br /> f 2. (off de REs _ - - — - - — in <br /> w <br /> C <br /> o <br /> $r jn <br /> rs Ot � <br /> ODf " o <br /> Sy/V�Sb.�yc <br /> 3 <br /> I � <br /> - <br /> g, P{ h <br /> - _ Quer loo lJ <br /> O <br /> I� z <br /> I hcai\al Cour) �lrK - <br /> OwRni�►��r r � <br /> Tc76nmo <br /> nam <br /> SPeSA <br /> Jb�hSoti r A - cm <br /> CONDITIONS OF PERMIT: .rJ�p o m N.:€�Z c 0 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE c £o ��Z <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. RI <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o' C <br /> m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- /I j1' $ B g <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I V, - 0 v3 0 <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 /> Ilcation. I agree to permit count officials charged with administering count ordinances or other authorized �' - <br /> P 9 P Y 9 9 Y person to have N" 0i <br /> i ON Op <br /> access to the abov ascribed premise at any reasonable time for the purpose of inspection. <br /> m 3 n0 R <br /> '^��^^ <br /> SIGN HERE �JL,lt-t <br /> (sig t re o ow r bullding contractor) (date) « <br /> � ' xE <br /> o ; <br /> ZONING ADMINISTRATOR <br /> H: <br /> 67 r«�« M <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N N N (Nn p N m <br /> 0 $ $ $ $ $ 000 <br />