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WYAP/ <br /> lurnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S m f c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> O THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> g by application for a Permit for the work described d � v <br /> Icated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ �� <br /> lurnett County Lend Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> 3gulations of the State of Wisconsin. w m <br /> m <br /> ,�/ /� 'q ,// C m O <br /> OWNER �/��j G D/L�/L'-GAY.0 �+'If.�j�f5 TELEPHONE 7/ � 7!B",�-Z 0 �� n E <br /> O = <br /> DDRESS &Oso 3k / //IPAN g we e <br /> MERGENCY/FIRE NUMBER A)/4 ROAD NAME <br /> EGAL DESCRIPTION (see tax receipt) �k) rY A)f Se- 9, <br /> CONTRACTOR /74; xv'e C l� 4eV S-a'W '� O <br /> J <br /> YPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> ANITARY PRIVY 11� 0 <br /> 1 FILLING/GRADING CAMPING UNIT SUBDIVISION o � <br /> TRUCTURE/ADDITION USE: I&b .Q. Z&O-9o ° rl <br /> (Home/Cabin;Commercial Business; edroom;Deck;etc.) Z <br /> O O <br />)IRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) " a <br /> I. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (NJ. <br />!. Show the location of the well (W),septic tank (ST),and dralnfield (DF). I o <br /> I. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)bull ding .1 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 1. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signs and M <br /> dated by the owner. O <br /> DOTE: BUILDING/STRUCTURE LOCATIONSMUSTBE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 rn <br />)LOT PLAN 5'e-e 1/do� W �l-aA mOlaw C� o n <br /> CGG{ M € N z <br /> c . i <br /> IN � <br /> N <br /> 0 <br /> _ <br /> IN <br /> 0 I � <br /> _ <br /> o <br /> w <br /> �j <br /> Z <br /> 1 � <br /> c D a O <br /> CONDITIONS OF PERMIT: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c _ M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> Qe € 2 i <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my nowl- i o C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- : .+m a E <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing int is ap- ' <br /> plication.I agree to permit county officiate charged with administering county ordinances or other authorized person to have p n <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 <br /> T 3 <br /> SIGN MERE <br /> M w <br /> (sign uro f owner or Ing contractor) <br /> I1/ <br /> ZONING ADMINISTRATOR <br /> � ' I MN ~MMN� Zt <br /> TOWNSHIP PER ITS MAY BE REQUIRE 13 ( J o <br /> �s8 $ $ N <br />