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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator owe -m' " y?o <br /> APPLICATION FOR — LAND USE — PERMITS s- - <br /> m , <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and n <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. a m <br /> NONE 443- 1083 C <br /> OWNER f)Dol_ PH c. r1 TELEPHONE $ l IE <br /> O <br /> �{.{{�D fes/ I O M N[7sI�r ,y lApk� �66A�17'¢r t 8 m <br /> A(SDR�I / A Etyr-P, Rn. Dox ;,?4 , Sr �Fa1x 1�/r4W- 101, v <br /> EMERGENCY/FIRE NUMBER3902 ROAD NAMEMALLARD 1k, D <br /> LEGAL DESCRIPTION (see tau receipt) LOT sl s r 1 4o N , k s w �- <br /> CONTRACTOR / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE6, R . ADDITION o <br /> n r7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> x�a� 0 = 3 <br /> STRUCTURE/ADDITION USE: C- ►b' � ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z c <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). g <br /> 3. Show dimensions In feet of thefollowing:(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. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. * Z c <br /> PLOT PLAN LAkE /WO , SAN, Y LAKE �.p£Ck QIJ( 3� � <br /> a <br /> FRIM <br /> cA6li� tb O <br /> Z4K 32 xZ4 7� r d <br /> s <br /> o <br /> 501 ? X24 <br /> Q0 , <br /> °OGht�A6E IC n <br /> 40r _ I,EWr <br /> KINE � C EpnC I6 71 w <br /> ` DRA10 FIELD TANK x <br /> 22i <br /> LoT <br /> � SOt , t LINE Z <br /> I S <br /> CMARKE <br /> Tu R�J 1 64 uj)1M <br /> AREA `1 Ron I <br /> - ----- Tawny GAD <br /> C _ a in <br /> 1'D oHA' m g $� o �Ay <br /> CONDITIONS OF PERMIT: v 3;: c �is 2, C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e 4 : : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - Eli i te: <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` Z' ` ) rn <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- : "' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i $ '. p <br /> motion 1 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 <br /> access to the above described promises at any reasonable time for the purpose of inspection. r <br /> SIGN HERE <br /> Rs=f of own r ullding contractor) (date) rl�g <br /> ZONING ADMINISTRATOR Sc�- ? ' 8iTOWNSHIP PERMITS MAY BE REQUIRED 'o ' $ '1i' i"L$ m888$ $',88 N <br />