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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u 7 a ' 0Z <br /> APPLICATION FOR — LAND USE — PERMITS 3 TO THE ZONING ADMINISTRATOR:The undersigned here app m g <br /> 9 by makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> regulations of the State of Wisconsin. m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all at applicable County Ordinances and the laws and 3 <br /> — o <br /> m_ <br /> ` " o <br /> OWNER M CY N I S cyI q All C C o L). TELEPHONE a £ <br /> 1/ I � 6' - 7av7� y a J <br /> ADDRESS P�` Jr /� . _ _ fD O!3 <br /> O oV', r^C'/`li r c.Or I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 �J <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Sw 'Z±1, 1 4 5w �1 Se tdr � aq T '1o IV R 1_7_k/ <br /> CONTRACTOR r0. s�crmj <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE(y�X.GbpADDITION <br /> �— o <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> J <br /> r <br /> STRUCTURE/ADDITION USE: _ � 2 e- <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) v <br /> Z Q <br /> o 0 <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (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 <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 be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '7I 3 <br /> 0 P <br /> PLOT PLAN an zo <br /> over 100"�:t TO aU m Q� a <br /> Other- "T- lle-eS <br /> M i <br /> 1 O <br /> p <br /> J <br /> ` � J <br /> L-. 0 <br /> pp N ~ <br /> fiC/qe <br /> R� ( &t <br /> s r�(nv(nr DD� � <br /> M <br /> CONDITIONS OF PERMIT: —g� � o-y�y n m m <br /> O < .: QCp JJ <br /> N � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 <br /> Z m <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° J =rn M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ,t"n ' L7 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infon m <br /> �I B g m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 b r$ o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I amrovidin <br /> p gin this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ONO <br /> access to the above described premises at any reasonable time for the purpose of inspection. mom . <br /> moo <br /> SIGN HERE -'J <br /> (si lure of owns uilding contractor) r )-'rl// r N <br /> ZONING ADMINISTRATOR <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED NQV 2 3 1.o UNI INn N N N p , m <br /> 000000000 <br /> L <br />