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� i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m `m <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. �, m <br /> w � <br /> OWNERAL �e�nerl�iMe�a k_r#6f CS0N TELEPHONE ���.. '157- 637ZI O F <br /> !7 /� IF <br /> / C m m <br /> ADDRESS4_5'% <br /> 3a- AkrCe o. SO. ST A,/, MN. 'TSO 7J m <br /> l <br /> EMERGENCY/FIRE NUMBER ROAD NAME/us�in� Q Mikehay/ (� <br /> > [(1 <br /> LEGAL DESCRIPTION (see tax receipt)- E 5 Wyq Of+he 5W V39 f 19W e vn /i <br /> a-Ae W. 12 Acres i-hereof, <br /> CONTRACTORAepmo BGildrur C'en,lC..¢.. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ARAG ACCESSORY STRUCTURE t/ ADDITION O CY <br /> 0 (n^ R <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a IJJ. <br /> STRUCTURE/ADDITION USE: �i4 ' ��,Q �� 1.� � r r_R1LwN/ <br /> ° <br /> (Home/Cabin ommercial Business;Bedroom;Deck;e . Z <br /> o ° <br /> v <br /> m <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 (W), septic tank (ST), and drainfield (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 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. 41 3 N <br /> '� _ <br /> atxa <br /> PLOT PLAN r. E 4ppr,1Y. n o o <br /> 1_ 20( N. <br /> WuT <br /> E ApProx 500 r <br /> _ m <br /> -To Roxb C APV ron�5so <br /> To RlveR <br /> M <br /> . o <br /> Q / N q, <br /> Q i <br /> I z <br /> !`A <br /> _ZS 'Ile <br /> 3/ 0 17Nr- D D p <br /> ° O. P a_ Zo ¢ 0 m <br /> a �. <br /> CONDITIONS OF PERMIT: 5, ��-, Z m o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 4 .4! <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' = ( m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I �' G) O <br /> E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 1D m 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 1 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. I a a Him <br /> IR <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- ie <br /> plication. 1 agree to permit county officials charged with administering county ordinances or other authorized person to have O N <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 <br /> T � <br /> SIGN HER I H I <br /> (sig to of ow or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSH PERMITS MAY BE REOUIRED <br /> Noo9m <br /> 8 8 $ 88x, <br />