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60 c- 1 ' <br /> Burnett County j410 Co. Rd-K, No. 102, Siren, WI 54872 Office of Zoning Administrator w - o 0 <br /> APPL CA's ION FOR — LAND USE — PERMITS 3' <br /> d o <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and 2 w <br /> located as shown herein. The L ndersigned agrees that all work shall be done in accordance with the requirements of the w m <br /> Burnett County Land Us@ Ordin ince,Sanan Code, and with all other applicabl County Ordinances and the laws and 3 n <br /> regulations of the State isc main. *ULa :) ��W-YL 0�._ 7 --3e -1' e <br /> ,/e 7X �, o <br /> F'/O Y w <br /> _ m —� O <br /> OWNER n TELEPHONE O/_ / _IVV7 l j a F <br /> /J(Qu y7 m_ ; <br /> r <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBE 6 B�' ROAD NAME �Q S$' <br /> l� n <br /> LEGAL DESCRIPTION (see tax re eipt) °u T AZ &`T �X ��3 P -� <br /> 7�5 911,4110 <br /> CONTRACTOR e <br /> NPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY-- FILLING/GRADING CAMPING UNIT SUBDIVISION o <o !� <br /> STRUCTURE/ADDITION USE: O <br /> E; <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc-) q Z o <br /> o <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 infest 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 subm tied by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a N <br /> �I Z `a <br /> PLOT PLAN <br /> o _ <br /> C ) <br /> a <br /> m <br /> Xis n y /�v �a, l a me ht oun tli( o ti <br /> J <br /> �usen�en has C.enere�� Pil7'io 77 Y3A a <br /> 0 <br /> -mac N� <br /> GUe pro!°os <br /> e2 re a <br /> l �1�3 <br /> ri'Af e q �,t S S 5 Creenn7q <br /> ltl/PaGh� JJ / , �✓✓ 1 / <br /> Y <br /> C' <br /> irk y tri o t1 e- d <br /> `��� Pps /'.S i <br /> JJ CVA <br /> Pett /vd o it P Q -}El ci <br /> m 37�� aaw ¢ 31 L1 M <br /> CONDITIONS OF PERMIT: < : Q C `� 0 �+ <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p m eo <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. H =y <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" : O 2 O <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,torr n and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : H y m <br /> tion contained in this applicat on(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $`i3 <br /> further accept all liability whi h may be a result of the County of Burnett relying on this information I am providing in this a y, <br /> plication. I agree to permit co my officials charged with ad inistering county ordinances or other authorized person to have m N p <br /> access to the above de,7 Dremises at any reason time for the purpose of inspection. 3 g <br /> T 9 <br /> L ' e <br /> SIGN HERE <br /> (ai at rcoLe er ilding contractor) (date) <br /> ZONING ADMINISTRATOR '�=t ' ' E E E g E X E <br /> �erw`n�enKe a►w " <br /> TOWNSHIP PERMITS MAY BE REOUIRED a'0 ulu, 1tM(Q' NNUP <br /> w <br /> 4 b b A O P <br /> 00014 <br /> M <br /> H <br /> N <br /> 0 <br />