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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. o <br /> TO THF*ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and z w ' <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 3 a W <br /> regulations of the State of Wisconsin. w d <br /> '' ..,,nnn l n o <br /> OWNER — �}� ll�T TELEPHONE r(o I')—) 94 <br /> ` � 1�L�otllslTr Jwcn1sC'T�• ��h'E Jv I E 11)/( 4�4A I L <br /> ADDRESS LRKfCO <br /> n <br /> U : <br /> EMERGENCY/FIRE NUMBER ROAD NAMEF, <br /> rop L-o-r <br /> LEGAL DESCRIPTION (see tax receipt) 5t-z,op c3'TwP 41 R I(� 6oU- Lc->T 5 EX V 113 PC15 V 7) <br /> coocW1z <br /> CONTRACTOR r7�nJ a2 �NaAGE ptct- - <br /> A+�6iYR'11��-� 22 0 F-1-01 U 223-?P <br /> W LL-L 0-4c «l '4 p,,J r4 ew— 9 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: ('d2 Slb( AA 2�r X Za 6AfLf�O'� �I U� ° <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) z o <br /> o a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I v rn <br /> 71 z `c <br /> PLOT PLAN o��p1G� n <br /> O a <br /> loop (^ C <br /> 0 <br /> CD <br /> I 2 <br /> 9 m <br /> r_Joy L�gTro J <br /> z� <br /> t A <br /> tiD <br /> -tgcc'eSs ao;fl-, m �o c i t I> a F 2 <br /> CL 00 g <br /> d iB 70 <br /> CONDITIONS OF PERMIT: v m •.`5,z C Tia <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ? o i p <br /> o : n E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- d+y G <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied 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 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 O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 <br /> a y <br /> (D <br /> GN HERE <br /> SI1 (�s <br /> y,; �( Gn : <br /> signature of owner or building contractor) ' 1 ' (date) <br /> 1000 <br /> 5fi, Am Y1�7rj P ZONING ADMINI OR L11 1 (Cxx is•NyXyN 1 <br /> TOWNSHIP PERMITS MAY BE REQUIRE _ _-- — o y^; M I ,n ;gm m <br /> 000209 o x x N <br /> 0 <br /> 0 <br />