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NAp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( m -- c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ so <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> IS- <br /> regulations of the Stale of Wisconsin. 9 �, m <br /> GIZ- ZG - 7�sC (�re� <br /> OWNER £ J Pan {1nE1LEPHONEe McnsPn 5Pc .�3 -7/S3crcrL fIIu <br /> o <br /> ADDRESS y37$ - 1'�AC ss.n� `1?7 A2- Wo 0 <br /> EMERGENCY/FIRE NUMBER r- <br /> ROAD NAME 1 1 <br /> s <br /> LEGAL DESCRIPTION (seetaxreceipt) O. l4 Ht� 37,3N SrS' O RrV4� n-5 .�Sr LY>d 51S7 <br /> . is.or7oo /OZZ L J.FI.lS.c3, ff ss'oo <br /> CONTRACTOR �//i V(�1 /rl OvvL 'y`- 3� ,r[b A, in c , r� T NInJ 5B Gf' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION <br /> » O <br /> SANITARY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> \- J �I m r- <br /> STRUCTURE/ADDITION USE: if f) t y\ 6jJ l Tr[lY'L �G�C-�t.9G ✓ic-'G) SP_ %C- a <br /> (Home/Cabin;Commercial Business;Bedroom; Dec etc.) y }2 Z <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). 0 <br /> 2. Show the location of the well (yi),septic tank (ST), and drainfield (DF). 4�— <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building (R <br /> measurement to the ordinary high water mark of lake,stream,or river. v 1 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. 0 ii <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an a y <br /> PLOT PLAN <br /> 1 � <br /> goofte j �cZ�� C i <br /> m <br /> CEsj — <br /> I <br /> �E'e 1�a(ianc3v Q cn <br /> a ,>I o <br /> r �i o <br /> Q <br /> m <br /> v � <br /> A19 �B EX%sfr�t-q CLbin •JJJJJJ <br /> a U <br /> n <br /> � NN vfn � DDp � <br /> i m O-cv'''2.M EE m <br /> c pa tae ro <br /> CONDITIONS OF PERMIT: �.j Q w $ �ao 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT UIREHtu nnvc nc acwnem ISSUANCE = m o ' t 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETA ALONG SHORELINE. e E ' ` ' =''r2 [ E M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS S — Ion In <br /> gn � E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- - o t <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- f ` O At <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- g u s O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I •9+a <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 <br /> access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> 0 <br /> ®r- <br /> SIGN HERE ` ' Inge <br /> (signature of owner qrlbuilding contractor) - o <br /> a <br /> ZONING ADMINISTRATOR f g E x E E <br /> TOWNSHIP PERMITS MAY BE REOUIREDffi' �?n �a'o o�b In <br /> 88888888m <br />