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C� cep, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m a c <br /> APPLICATION FOR — LAND USE — PERMITS 3. ' <br /> 0 <br /> TO THE.ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <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 <br /> regulations of the State of Wisconsin. m <br /> OWNERH / 1 �/ NJ �E7�G�TELEPHONE <br /> T <br /> ADDRESS5/� S4�S <br /> EMERGENCY/FIRE NUMBER 2 �' "] Cj �J ROAD NAME ��r�, f Q <br /> 1 /pA L A2 ) <br /> LEGAL DESCRIPTION (see tax receipt) �/,L•J! .SEC 6, /71 .Sc'C /4nfnn/n <br /> i 'SFO N %4 {/�. "ToT-J.�✓ d't- SC o T- T/ <br /> CONTRACTOF, , e t �,K <br /> TYPE OF PERMIT(S): DWELLING/BUILDING R�A&ESSORY STRUCTURE ADDITION o <br /> n 47 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> /' C) <br /> STRUCTURE/ADDITION USE: c;2 / T �ol �Jf'7V^{G,�Q i ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> 0 o V <br /> } <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 infeet 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 _ <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o to <br /> c <br /> 11 z v <br /> PLODPLAN �ozTff o a^ <br /> h X C <br /> yy)tF� �alz SG6 02 �7 F � K C-) <br /> sag° O , <br /> m <br /> 0 <br /> 0 0 <br /> lr�W,E Y s 4 - <br /> o <br /> 2q G.APZACe <br /> b e A /ems f <br /> �Sm G�'t�ke <br /> G7Qo � ' Offal <br /> 3,y „ice .ice— n > a m m <br /> g� 2.a0 <br /> m cN O j i <br /> CONDITIONS OF PERMIT c ?, Z T� o ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> C1, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. y.� N o <br /> 252 : 1 m <br /> o : ; � � ; O <br /> —( $i o C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- " »d n: T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. Bo : a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o <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 0" o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 bo <br /> 9 A x <br /> a A . <br /> 93 <br /> SIGN s <br /> SIGN HERE � ZJ <br /> (sign re of owner ilding contractor) <br /> ZONING ADMINISTRATOR i <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> APR 7 O N N N N O m <br /> I1 00000000 (a <br />