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0),1 C)J�). <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d '1 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 m <br /> regulations of the State of Wisconsin, y o �M1t <br /> c <br /> m <br /> OWNER :ter`-�F1PY Int Gulobe. TELEPHONE I-S(o _ 3SG � o- �1 O <br /> o J � <br /> E r m <br /> ADDRESS -P C. 14 0 r S c <br /> EMERGENCY/FIRE NUMBERc1°i`.� ROADNAME <br /> Pard:�n S Q �.•er iii ncs LAA 'g-1 4- ` to lit -r-A ',n Oo t <br /> LEGAL DESCRIPTION (see tax receipt) 00 -4O r n Ib tJ , r� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION o <br /> o <_ <br /> STRUCTURE/ADDITION USE: h P_c lrI �IP� /� U %- o 0 L <br /> (Home/Cabin; Commercial Business; Bedroom:Deck;etc.) m <br /> z <br /> o <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1 <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). o <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto 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 MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 3 ur <br /> PLOT PLAN z <br /> o n <br /> M <br /> O <br /> C ) <br /> del low P,'I m �I <br /> I <br /> rr ' 1 <br /> Z I /.)0 <br /> aril o � <br /> • 2. <br /> • o � <br /> Sep RC J <br /> 143o <br /> I 9, <br /> 4 2 <br /> C• (-f Z <br /> r <br /> fb <br /> l <br /> /I miic�wy>a� m <br /> m — 9' '" am g, m m <br /> CONDITIONS OF PERMIT: o m 5._ c 8 N'5 <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F S� i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (� � o i O 2i i m <br /> 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- <"m n: T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- o ; t7 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o <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 ONO <br /> access to the above described premises at any reasonable time for the purpose of inspection. : rob RL i <br /> m : <br /> I to : : U A N : <br /> SIGN HERE '_- Q G Q t,.� I 1 C1 <br /> M 1 0O <br /> � <br /> (signature of owner or building contractor) (date) ow <br /> - <br /> ZONING ADMINISTRATOR1(Yl f /- aru'Qi;/o e/E ' 8 <br /> ' 8 : i <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Ofn NNc p m <br /> OOOOE ocy <br /> P <br />