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r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54672 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. ' _ <br /> ' � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,c, <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ n <br /> regulations of the State of Wisconsin. w d <br /> / �7 7/S ZS9 3Z 95' a – 70 <br /> OWNER �/JD//'f�S L . 5"�4�U1sr TELEP ONE E <br /> '�,ae.>s... <br /> �9i91 Y —x/962 m <br /> ADDRESS �/3/� L.O. T4• �7' _�/ S/may m <br /> EMERGENCY/FIRE NUMBER Z939l ROADNAME L p. �d, y <br /> sc — v zS 3SB <br /> LEGAL DESCRIPTION (see tax receipt) .SO Sym ybl��f�sr/ �At.rEs /. Yyo <br /> CONTRACTOR Self <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION o . <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° <br /> STRUCTURE/ADDITION USE: 'Vr4r o //O�S�3'OO o <br /> �/ ° <br /> (Home/Cabin;Commercial Business; Bedroom Deck;etc.) z o <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <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). <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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a to <br /> 11 zcc <br /> PLOT PLAN <br /> (7 o n <br /> 100' <br /> to m 00 <br /> drain C I <br /> field to <br /> M <br /> ~36' l <br /> 24' new garage <br /> 60' <br /> f to 5' o lot line —► N <br /> lot <br /> line � m <br /> o � <br /> N <br /> privy \ <br /> 7' <br /> s O <br /> ptic <br /> z <br /> driveway x <br /> I <br /> 60' to well —► <br /> '5wtf>e-, &--o7— /5d-30 Existing <br /> screen <br /> porch/bldg. <br /> M c 3 g oaf 17 <br /> m vg's a» a= 9 <br /> CONDITIONS OF PERMIT: ^ < y': C8 3 ro +T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F5. <br /> �Q = <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !^ L) m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- y? o: m l 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- e+ym <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i o 5 : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o 0 <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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> M l O <br /> SIGN HERE, E E i a E <br /> nat a of Owq#rr 'ding contractor) (date) <br /> FEB I1 E <br /> ZONING ADMINISTRATOR }//Mn ' g '. '. <br /> N N 4f N N I\) N <br /> TOWNSHIP P RMITS MAY BE REQUIRED m lu\� _ _ — —"' ����o a� T <br /> 000008o0rmil <br />