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I Vrt w 1 ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr bed and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremei its of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the aws and �_ d <br /> regulations of the State of Wisconsin. o <br /> w m <br /> C <br /> TELEPHONE <br /> Z2 1P 09 OWNER nm <br /> O <br /> j5p o �n <br /> ADDRESS Q �G � <br /> TEL <br /> m' t <br /> I <br /> EMERGENCY/FIRE NUMBER ROAD NAME ikC <br /> Z .c <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) .# yZy Do f C D l n (Z <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o (7)j— <br /> N <br /> STRUCTURE/ADDITION USE: 914, g <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) fmqz 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view)1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate Non (N).2. Show the location of the well (W),septic tank (ST), and drainfield (DF).3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)buildingmeasurement to the ordinary high water mark of lake,stream, or river.4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sI ned anddated by the owner.NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED.LOT PLAN <br /> /y A o a <br /> j, m <br /> Vir' -E'x.S f�N5 0 <br /> C <br /> yq�a9` m <br /> 1 <br /> s <br /> 0 <br /> ` 0 <br /> S.T. N <br /> m <br /> O � <br /> N <br /> i /z'Y 1s ' o j{arc 7J <br /> //Y afro r+ ale � <br /> 0N51kt- 11-/0-I5 9ca 3o / <br /> Oe Sdjnck. - 5-7 - /, poo `f< / <br /> i lakxl$f etc. atQl<( O = ,.<,< !I > se , <br /> S,+e 991v.t)y <br /> �F <br /> M', (roz"d 1,1cc /2c1. / "� 8 9/ fie - ,ibl�s l a v saov <br /> Dg '� oa m <br /> CONDITIONS OF PERMIT: ' $ w. Z c g <br /> nNrdt vyr1��.�ns yY ' r6< : Y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH z REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o :OE So <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rr� : O mO <br /> — : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- <"m' T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that his infor- $ B G <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I gr$ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing i i this'P- <br /> plication.I agree to permit county officials charged with 40ministering county ordinances or other authorized perso i to have p <br /> access to the above described promises at any reason le time for the purpose of inspection. ' [ <br /> SIGN HERE w <br /> (sig wr building contractor) (data) € ` <br /> 0 i <br /> ZONING ADMINISTRATOR J: $ <br /> Mw�r,M � <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8- N N 8 NN m <br /> 7 ' ' : : : : <br /> 88 '8 $88 w <br />