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t3 ` eorrupJ <br /> Bumett.C»unty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminls rotor m ' o c <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ie ° CG <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 Is and 2, <br /> regulations of the Stale of Wisconsin - o <br /> m <br /> u m <br /> OWNER pv�•� 0D TELEPHONE( <br /> L r-!� <br /> ADDRESS 36 9D a-�J ,e Ct r'� L� LG.eC L.JZ J <br /> EMERGENCY/FIRE NUMBER *; 0 ROAD NAME <br /> O�- L1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> ^ _) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION P/I7 d/Gj o <br /> SANITARY PRIVY FILLING/GRADINGCAMPING UNIT SUBDIVISION o <br /> 1 0 <br /> m <br /> STRUCTURE/ADDITION USE: /J�� o 0 <br /> (Home/Cabin;Com tial usiness;Bedroom;Deck;etc.) Z <br /> o <br /> 0 <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 (14). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions Infest of thef011owing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE TIONS MUST BE STAID FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. v <br /> N <br /> PLOT PLAN 91Z `v <br /> LiA7U AGS , <br /> O()er 600 <br /> T � -� <br /> I <br /> A6 a <br /> I <br /> J <br /> m <br /> v <br /> Z <br /> f <br /> �i <br /> / 111STRICTED <br /> 9CONDITIONS OF PERMIT: (�i m 2 �aow' Zc8 = <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUN 60 DAYS OF PERMIT ISSUANCE. Z m S': - Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETAALONG SHORELINE. p E ' : ' N! <br /> 71 <br /> declare that this application(including any ac panyi c 4 : , <br /> ow <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all inf rma- m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this'nfor. a <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a per it. I gv g <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in th a ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized personto have t 0i o <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERES` �. 'A 69 <br /> w ` <br /> n ure of obuilding eontrectop (date) <br /> ( ' <br /> ZONING AOMINISTRATO 8 : ; <br /> TOWNSHIP PERMITS MAY BE REQUIRED `1195 N m <br /> oai�ii $m <br /> 18 $ 8$8 $8 MCA <br />