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Vrrl <br /> Buffiett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS c <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes <br /> 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 /> 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. <br /> m m <br /> OWNER Ct1hfU(K • 1 TELEPHONE 617 <br /> N 1 0 <br /> m <br /> ADDRESS 53.53 0ih Z'7sr• A1'i' IZ WyoMirJc� ; Mfg. SSOCIZ m n <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> V <br /> LEGAL DESCRIPTION (see tax receipt) <br /> r1 <br /> Vi <br /> CONTRACTOR r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION_T I p }( <br /> SANITARY_>( PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 0 <br /> STRUCTURE/ADDITION USE: �Y.1�\j (:1�.I1 lI�- - "\I�-�T� I�il ETA-�Ly o 0 <br /> (Home/Cabin;Commercial Busiposs; Bedroom; Deck;etc.) <br /> 0 0 <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) w ` <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 Infest ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building ry� <br /> measurement to the ordinary high water mark of lake,stream, or river. IIS_ <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 y <br /> PLOT PLAN o n <br /> � C w <br /> Cm <br /> V Ifii <br /> w <br /> cnm <br /> O <br /> O <br /> ?. <br /> -y <br /> Z <br /> I � <br /> m �=5F$af m <br /> CONDITIONS OF PERMIT: ^ < w.: Q g rB gm <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m 03 i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, I P F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N O n In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl. <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of al informs- i »m» rn <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps n to have o <br /> access to the above described premises at any reasonable time for the purpose of inspection. nn <br /> n a <br /> ./� / <br /> a <br /> ' �`�: _ m <br /> l�INLuwA I Z ' CIS » ? <br /> SIGN HERE '� <br /> yafgnahf (date) ' $ <br /> ZONING ADMINISTRATOR ' E <br /> TOWR <br /> NSHIP MITS MAY BE REQUIREDN <br /> »» »»» rn <br /> ISm <br /> $ $ $$ vmi <br />