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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator VNOa o f o <br /> APPLICATION FOR — LAND USE — PERMITS . >< <br /> m = <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and Q u <br /> located as shown herein. The undersigned agrees that all work shall be clone in accordance with the requirements of the u C lA <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. - o <br /> Rt <br /> //— w <br /> l0 I -5 O m <br /> N 1n J TELEPHONE <br /> OWNER j . J r O <br /> ADDRESS ,, ke- u2. <br /> EMERGENCY/FIRE NUMBER i r I - \ <br /> ROAD NAME K 1 . L' �0 I - P _ <br /> LEGAL DESCRIPTION (see taxret ipli L.. N F.o� <br /> CONTRACTOR <br /> QJ <br /> 11 <br /> ���� <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION_ p <br /> C) <br /> SANITARY PRIVY FILLING/GRAD G CAMPING UNIT SUBDIVISION o lc <br /> N <br /> STRUCTURE/ADDITION USE: �R 4r� 4,d.Q. — p o <br /> (Home/ abin;Com tial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLA14 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 thew 11 (W),septic tank (ST),and dralnfield (DF). <br /> 3. Show dimensions In feet of he 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 subm ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and 3 <br /> dated by the owner. () 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STARED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN v y <br /> PLOT PLAN Z ° <br /> � o n <br /> � o <br /> / C , I = <br /> (� \ t0 0 = <br /> 10fey � <br /> I <br /> Lt /.Ns Z <br /> rn <br /> �jw�a,�e o � fK�s7Ore3d � / <br /> 7b �be ya �Ltn%/�/h > o rnrn <br /> CONDITIONS OF PERMIT: $ a � 13 C g 9 <br /> g z 8 = 33 <br /> t. DRIVEWAY MUST MEET Di IIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> o ! _ <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` r^ i i m <br /> Z; <br /> I declare that this application(1 hiding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> g and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- '• i <br /> E ` C <br /> edge cont res - <br /> D g � «a « <br /> tion contained in this applicatlo i(including any accompanying schedule)and I further declare that I recognize that this infor- In <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit coun y officials charged with administering county ordinances or other authorized person to have ' <br /> access to the above bed remises at any reasonable time for the purpose of inspection. <br /> //Q T <br /> V <br /> SIGN HERE <br /> pig t ow ? ilding contractor) Imo' r? - .mate <br /> ZONING ADMINISTRATOR '/G $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,ASI 3 1994 9 41" <br /> ' « <br /> «�±N«tin«««� �t <br /> < ! OrN �,� oNi�uNipm <br />