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coo <br /> Burnett County 7410 Co. Rd. K. No. 102, Siren,WI 54872 Office of Zoning Administrator m 0 1 a <br /> . ' <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 Cc <br /> m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ Q <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the maws and _ <br /> v <br /> regulations of the State of Wisconsin. m <br /> m <br /> $ f <br /> OWNER.,#AQKI ,� Gf/�s7`.l�p.� TELEPHONE I71S-_ d3y1—ZS�(o o_ A <br /> ADDRESS 112 /O eRosSTOuii✓ 14 <br /> EMERGENCY/FIRE NUMBER //2 /Q ROAD NAME C.Possrow�✓ I ^\� <br /> (� W <br /> LEGAL DESCRIPTION (see tax receipt) F/a,c,J #, SEX <br /> CONTRACTOR S�I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 0- <br /> a . <br /> STRUCTURE/ADDITION USE: u � <br /> (Home/Cabin;Commercial Business;)§edroom;Deck;etc.) o i <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 3 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). I r <br /> 2. Show the location of the well (VV),septic tank (ST), and drainfield (DF). I ° <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> n <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1! o to <br /> 1A Z c <br /> PLOT PLAN Al 0 <br /> C 4__ w SOI <br /> C <br /> s <br /> PRO�csS�D <br /> 1&51 7-0 II' <br /> ppr vY AZ A,<l�fd GI/ 1)2 lNi9r2�C' �I k <br /> 30 ' x 4z N i <br /> m <br /> a <br /> 30 ' X 70 ' FV7V0e1F II <br /> 1 <br /> I /YJovn�p sY-rMY4 I z <br /> �t9UV�i 0 QUer Sd� Tc' 1 <br /> 7•o N�9R i Aft I�fi If�e <br /> .40r t Ilve a) Rr.yA be ua f <br /> "{-o filrou.,c� t.war- y <br /> V T T�W l M <br /> o <br /> 1E.�zC=8g1ic <br /> CONDITIONS OF PERMIT: Z e '. V2 ; -1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. P E : XI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> C <br /> I declare that this application(including any accompanying schedule)hes been examined by me and to the best of my knowl- 3 rn <br /> y m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accurst of all informs- � <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- t7 <br /> matlon I am providing will be felled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I spree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premi"g at any reasonable time for the purpose of Inspection. , <br /> i <br /> do <br /> 9— 7-9SL <br /> SIGN HERE (date) <br /> (sign ro f owner or t ing contractor) <br /> ZONING ADMINISTRATOR 8 - <br /> TOWNSHIP PER S MAY BE REQUIRED S is m <br /> mn <br /> 8 88 8 8 f <br />