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BurrNtt County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Admiolstrator U -0 £ o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work clesc ribed and Q i (30 <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 <br /> regulations of the State of Wisconsin. M <br /> OWNER Bte'h f/e' s Lt-� TELEPHON �/ _.2 ? off? <br /> o n = <br /> J C7 / ! £ <br /> ADDRESS / A �j��� <br /> EMERGENCY/FIRE NUMBER �-� /`}' Y ROAD NAME SCof OYIz /tC/J `"/ <br /> LEGAL DESCRIPTION (s a t2 ec fif 1 <br /> r/ 22V--25!14 <br /> Ga.. <br /> CONTRACTOR <br /> 'Pill- <br /> //�/e )3eh d/ /w r <br /> C f <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY_ vl� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> �o c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) �y <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate No h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (DF). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c building �'.1 <br /> measurement to the ordinary high water mark of lake, stream,or river. N <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be at ned and 2 <br /> dated by the owner. O 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFrE VERIFICATION BEFORE A PERMIT CAN BE UED. y <br /> PLOT PLAN A o a <br /> � � o <br /> fill <br /> -J-- <br /> 9) <br /> p n <br /> _ <br /> 9L) . <br /> yew; fed _ 04A <br /> Z <br /> am. 98a3EM <br /> m, D K'l 2 a e 9- y <br /> CONDITIONS OF PERMIT: v < z,: c s 0 i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E IQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> aE � <br /> 9. NO GRADING OR SHORG)ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. � !n : E gi m <br /> PD (including Yaccompanying 1 yknowl- <br /> edge <br /> � ` C <br /> I declare that this application includin an schedule has been examined D me and to the best of y knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a H ; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- }5 B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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 <br /> SIGN HERE 00 <br /> - <br /> signaturo of owner or wildingc t Il (date) <br /> ZONING ADMINISTRATOR I Q ' l' 285 <br /> TOWNSN PERMITS MAY BE REQUIRED N!X N m <br /> �888888w <br />