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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U f o <br /> APPLICATION FOR — LAND USE — PERMITS m o TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v 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 <br /> regulations of the State of Wisconsin. jee m ^' <br /> �s m <br /> 1 7 > n O <br /> OWNER � YVI TELEPHONE <br /> ADDRESS Q 6 Q� � r + <br /> �' AC.3 7 <br /> �NS 657y /V.EMERGENCY/FIRE NUMBER IROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) SCG C`f cC �g�( r ee iyo <br /> CONTRACTOR t (�,i i j D'V% ,er$a/1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 6 o_ o <br /> STRUCTURE/ADDITION USE: �Gd!'tfi9s'r7 �O JY1 G - <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 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). I r <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. <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAYED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o N <br /> // P � / � ,I Z o <br /> PLOT PLAN f y ! pOST� /`O 2� /�� <br /> �rQmfeW 1[ Si e ortamc �e l ` "� t o <br /> Frain l,�e a '@du«�ie � v o e ro✓� <br /> o -� <br /> 3Y00 <br /> Ale z <br /> 91 <br /> 2XB Z <br /> A � <br /> /e00 ✓ f P/ L,✓ >\ f <br /> Ca <br /> CONDITIONS OF PERMIT: ` i 'a' ? °i o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F _i <br /> 52 i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ i . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ro 0 <br /> 8i iC <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S i f m O[ 9 <br /> edge and belief it is true,correct and Complete.I acknowledge that I am responsible for the detail and accuracy of all informs- : - yy!�m m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ; 7i�'m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 $ m 8 <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- w <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 premises at any reasonable time for the purpose of inspection. , 3 g p ': <br /> y A s . <br /> !?Z-- <br /> J O A : <br /> SIGN HERE <br /> (ai slur of owner ding ntractor) (dale) 8 <br /> Fr <br /> ZONING ADMINISTRATOR - <br /> OCT 13 1992 i' <br /> TOWNSHIP PERMITS MAY BE REQUIRED rn N N N O <br /> 888888 8 <br /> �C �- )D-13-� <br />