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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 00 <br /> APPLICATION FOR — LAND USE — PERMITS d 3. 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 1 m <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. - <br /> rn w <br /> '^ m <br /> OWNER rl�--AN A t,taYU I-Ol4 J zjl_t r TELEPHONE hog-Q pa7y n v O <br /> o <br /> ADDRESS 6V�% LLew. pr 0.:_4_JkpL L. ��, (ao510 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �h�Qert acQ I rJ e 5�o R d <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) Lot Z Goo Loi A, Set_A 1 1_4io%4 R\S N) <br /> CONTRACTOR`�eter Se Co d s U <br /> TYPE OF PERMIT(S): DWELLING/BUILDING---i GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> ' I <br /> n G1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a 0 <br /> \ � r <br /> STRUCTURE/ADDITION USE: S U,VA yY1a.Ir R c me s 2 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z m <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 (ES) 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 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. <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MU,S/T BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 rn <br /> NO <br /> PLOT PLAN `/Ff o o vJ l We � � IAII <br /> m q� _ <br /> 3 b <br /> w» <br /> s <br /> 0 U <br /> g <br /> Num d r r N <br /> a DQ <br /> cxs'-� ro o�t <br /> 0 <br /> N <br /> P r o y <br /> ~ f <br /> Iry T- <br /> 0 g ; <br /> .Ntw qq Z <br /> ;4 o F <br /> D - a <br /> Whls cy;N Q ItJes � d 3 <br /> 7V r�mv(n�D m c �.wwo �O <br /> 0 -'. G w <br /> C NDITIONS OF PERMIT: c � _.: z CS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N - <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> € m <br /> g: C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- .6'.: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o i p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 e� e <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 O N p <br /> access to the above described mises at any reasonable time for the purpose of inspection. a <br /> w m <br /> In a83I ' <br /> N b p 0 <br /> SIGN HERE <br /> (si at of owne wilding contractor) (date) '. <br /> o ; x: <br /> "ONING ADMINISTRATOR 8 <br /> -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED N <br /> N N W N V <br /> o v u m u, m <br /> 0000000 0 <br />