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Burnett Cougty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ���0 0 O <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. H m <br /> c <br /> 1 m O <br /> OWNER TELEPHONE� Fr,endsk A L, TELEPHONE �oIOZ - yd3_�99q m — <br /> ADDRESS fo�7-36v LJOJec- .Urr de- App)e �ct �• SS1.?:K m <br /> EMERGENCY/FIRE NUMBER ROAD NAME Road 1 <br /> I A <br /> p.,+ o{- GoU to+ I 141W _Z) � <br /> LEGAL DESCRIPTION (see tt"recceipt) {-O't 7C5 "f/tf/' / `J 0JO� <br /> ,I�r <br /> CONTRACTOR Cf•1 I A. Fr,-cnJ6,4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING // GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 1 <br /> m JSTRUCTURE/ADDITION USE: 14OVt'le/Cci6t n E; <br /> (Home/Cabin; ommercial Business; Bedroom;Deck;etc.) Z <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) S <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). T <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (D17. l <br /> 3. Show dimensions infeet 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 bf signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a ur <br /> PLOT PLAN0 Q <br /> o a <br /> T��r ROo,d ---�Z a <br /> 3 <br /> DF <br /> Uj° 3a� <br /> Q II <br /> �V o �V <br /> 006 <br /> a Ip` <br /> $0 N B o' <br /> o- � s A <br /> ya/ Pitt _ <br /> 1 I-3.4 /.: d <br /> Dom=K <br /> z <br /> I 78' <br /> pi <br /> NCKenzie-, <br /> D m <br /> CONDITIONS OF PERMIT: ,2 �$ 0,o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m gQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ =N <br /> N; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u+ : 62 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> gB ' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- w a.n m <br /> tion contained in this application(including an accompanyingschedule and I further declare that 1 recognize that this infor. `.: ij 8 <br /> PP (� g Y 1 9 D <br /> mation 1 am Providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0(9 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- d, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to haveO N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 0 <br /> D m A N ; <br /> 0 .SIGN HERE <br /> (si at f ner or build' ontractor) <br /> o : FV <br /> ZONING ADMINISTRATOR '� ' o ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0 0 0 0 0 o o <br />