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eyL e&�7p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn '0 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS ` <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m <br /> Ig by application for a Permit for the work described and Q u <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 O <br /> w <br /> OWNER t1L JQVr�eC(., K 61e TELEPHONE _i7a <br /> ADDRESS c�-20 <br /> VO0 <br /> 11at., 25- <br /> EMERGENCY/FIRE <br /> m <br /> E <br /> NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) S'�'-yr �,G a�C/Tu D` f, VLU <br /> CONTRACTOR A �- `f z u l I4--e77 <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGX GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY X_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> . r <br /> STRUCTURE/ADDITION USE: pW' o) o <br /> \ <br /> (Hom /Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <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 drainf laid (DF). <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. 0 <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ItMill <br /> v N <br /> PLOT PLAN Z cv <br /> o o- <br /> O <br /> Cl <br /> fn � <br /> 00 C I Rl <br /> I m <br /> _ a <br /> 0 I04� <br /> O y <br /> y <br /> z <br /> I � <br /> i; <br /> gafm <br /> '^. 77� <br /> CONDITIONS OF PERMIT: Z < �': Q g 8 i <br /> 1. 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. P F y <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' i Q On <br /> n, i . ` C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- �Ji o : i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- : 8 l 9 1 p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i i i $� $ <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 /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> al <br /> SIGN HERE N f <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR t 1m 1� , 8 i <br /> NMN+N M N N+ T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N$V, .8 m <br /> 991"888 888 ai <br />