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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 'a z <br /> APPLICATION FOR — LAND USE — PERMITS 'W <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H o <br /> 0 <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. u _ - <br /> q � �1 <br /> OWNER Rt`�t1. /- �U•�tl +�orh a-�t, Wy�a j TELEP/HONE 6-/_j <br /> ADDRESS4v-e . , <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) � � � Ora� IGnr1 5��� !'NS S<'C'r'•'O ✓1 �y <br /> CONTRACTOR r�, 4 n rG" P/ 74 -016 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> y O <br /> SANITARY PRIW FILLING/GRADING Y\ ^ L7 <br /> CAMPING UNIT SUBDIVISION o <br /> 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabm;Commercial Business; Bedroom; Deck;etc.) Z v <br /> 0 0 <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 (N). <br /> 2. Show the location of the well (W), septic tank (ST),and drainfield (DF). r <br /> 3. Show dimensions in feet ofthefollowin 0 <br /> g:(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 M <br /> dated by the owner. O <br /> NOTE: BUILD(NG/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 <br /> PLOT PLAN (( / 0/ {� t �J/ 71 Z v� <br /> ajs <br /> m <br /> R; <br /> �Qnrc � o s o <br /> z <br /> �� S haws 4, Le �� � ��D � /de o <br /> �, Qeol AfFA -.6 creme � 1�v r•� IN <br /> es fib 1X- ✓>reorrQu owl <br /> s19e.1 -�6 Ae y0144e( ati o�,_ it, Slaprlo z <br /> atN4-o � )IL -/Y- // x <br /> slope s c_Ive&l4v thAr la c/o <br /> o c ry m a T <br /> CONDITIONS OF PERMIT: <br /> a m c ! °i c 00 0 5 3 <br /> 7. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a ? r'R <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. In <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> 8 c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S : m m D <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- v, m to O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- x'ro <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 $ <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- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to the above described premise any reasonable time for the purpose of inspection. 3 8 R <br /> A <br /> m <br /> A P H <br /> J N g <br /> SIGN HERE '-' _ �7<s �- 3 -�� `/ •" [ <br /> N <br /> w ; a <br /> (sig tur of owner ilding contractor) (date) <br /> o : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> V N O N O O b m <br /> 88888888UM) <br />