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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v+- 1-Z <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:Them <br /> located as shown herein. The uat Makes application for a Permit for the work described and O a = <br /> Burnes County Land Use Ordinance SSaMtffibn Code,and with all work l <br /> ottther applicbe done able County Ordinancen accordance with the s and the lawuirOments s athe <br /> nd �. $ <br /> regulations of the State of Wisconsin. <br /> 'a <br /> 1 w <br /> OWNERyLI h10A SC.Y1.0 r~ 14/(22 TELEPHONE -7/ S -3,RC _. 31Q e E <br /> ADDRESS 10-) <br /> O S LO H- IZ Qp1 19 <br /> 13ctS0 S-4'G/ 6 m <br /> EMERGENCY/FIRE NUMBER )-1 p h�,_ ROAD NAME p <br /> fJ r�LS$ �✓.1/Ca /2 r� <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Gav � �o + y S« a3 73e7 IZ , � <br /> CONTRACTOR C &a n } I <br /> U <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�_ GARAGE/ACCESSORY STRUCTURE <br /> It <br /> ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNfTO <br /> SUBDIVISION - o <br /> o q <br /> STRUCTURE/ADDITION USE: !n ' <br /> 8 0 <br /> (Home/Cabin;commercial Business;Bedroom;Deck;etc.) � <br /> Z o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9J <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). I� <br /> 2. Show the location of the well (W),septic tank(ST),and dralnfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot tines,(b)building to carnet line of road,(c)building IQJ o <br /> measurement to the ordinary high water mark of lake,stream,or river. 11 111 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and IT\ <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. O c <br /> PLOT PLAN o c <br /> 6aSS L0, Ko— « o n <br /> w c l <br /> D c" slab <br /> SU <br /> fG ti(; <br /> F-7 3 s � <br /> �- 02-- 0 <br /> m <br /> 0 <br /> N � <br /> r <br /> Q I <br /> )40 -7 <br /> ' J <br /> sD v Z <br /> r1 I S <br /> D <br /> N•t t7 v r, p Sc�fl r{�7�i,1 I P/m�e �, f <br /> JJI�011 T <br /> a Q <br /> Inn <br /> 7. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WRHIN fi0 DAYS OF PERMR ISSUANCE 2 Z.• ? C 8 •'� IC <br /> I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° ' ' - ` - 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Zn'i ` rn i = <br /> I declare that this application(including any aceompanyinp schedule)hoe been examined by me and to the best of my knowI- o ; a7 ` RI <br /> edge and Delief It is true,correct and complete.I acknowled •that I am res . <br /> tion contained in this applleatlon(including any aeeompanying schedule)and I fubrthe�declare that Idrecogn s that all <br /> n oint e• <br /> motion 1 am providing will M relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I In <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• 8 8 ' <br /> plication. 1 agree to permit county officials charged with administeringcount ordinances or other authorized <br /> access to the above described premi s at any reasonable time for te purpose of Inspection. person to have <br /> SIGN HERE <br /> g - 3o-y « <br /> (signature of owner or building conn({raQ�,to{q� (date) <br /> ZONING ADMINISTRATOR /� �'`�T' "1 GO <br /> • i 81 i ' <br /> TOWNSHIP PERMITS MAY BE REOUIRED ' '4 ' i ss m <br /> 888888188 w <br />