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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 <br /> APPLICATION FOR — Office of Zoning Administrator �, 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby LAND USE — PERMITS F <br /> m <br /> located as shown herein, The u application for a Permit for the work described and ° <br /> Burnett Countynce,undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> regulations of heState Use <br /> Wiscons n'Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> OWNER A0 4 8hoZm <br /> N TELEPHONE n ; <br /> ADDRESS <br /> go k <br /> EMERGENCY/FIRE NUMBER `` <br /> ROAD NAME Nv RI� W (� <br /> LEGAL DESCRIPTION (see tax receipt) 0 _ — <br /> cl Lo L �� %- <br /> CONTRACTOR t <br /> � cs actn�li� lS-�3v— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING <br /> X—_ GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING <br /> CAMPING UNIT SUBDIVISION 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: }� <br /> r <br /> (Home/Cabin;Comrhercial Business;Bedroom;Dec c.) o <br /> Z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) o <br /> I. 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). <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. 71 <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '� 3 <br /> PLOT PLAN p rn� <br /> 0 3S st y>'✓Jd� 0 o <br /> 6� n� <br /> 7� m o� <br /> M <br /> M <br /> Q <br /> N�� s <br /> C <br /> a <br /> N <br /> O <br /> D <br /> m <br /> •ttJ�( o <br /> y 1 <br /> ----- Z <br /> o � <br /> Imo^, <br /> � 1 <br /> �'f <br /> CONDITIONS OF PERMIT: S1ruic k-oao� <br /> =94 2.a m CL m m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 0 ? C 0 OCRrb <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> ° fes : 41y M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> a52 m <br /> - <br /> y (.fy gE E' : C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- II �' <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this rma H m h` m <br /> mallon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a ` IV � t7 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing In hisiep g 8 <br /> Plication.I agree to permit county officials charged with administeringcount ordinances or other authorized <br /> access to the above described promises at any reasonable time for te Purpose rPyose of inspection. person to have <br /> ro o <br /> -n <br /> �: <br /> A 2' : mIGN HERES « <br /> oo .(sig no r 3 <br /> E <br /> or building contractor) (date) ' e' <br /> ZONING ADMINISTRATOR i <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ««.»~»««8 rn <br /> $88888188 ai <br />