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V I ! `zyn-Pi <br /> Burnett Couftty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS ' 0 <br /> m <br /> TO THE ZONING ADMINISTRATOR: rho undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 2 <br /> regulations of the State of Wisconsin. H d <br /> OWNER �/U L(. V • &}_6 Lj r\) 14 9 o £ <br /> TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER V > ROADNAME aEl JE <br /> LEGAL DESCRIPTION (seetaxreceipt) or '1 G° ►.0'x'1 [ t Se(„ -IL-t <br /> CONTRACTOR Q¢-,e O p W st <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDrrlON O <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> r <br /> STRUCTURE/ADDITION USE: \" t1_VS C_ Ho Ya¢. SR-e SONAI 1lot) UD1%)ttVtltA 1 S <br /> (Ho a/Cabin;Commercial Business;Bedroom; Deck;etc.) J Z o <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of a I existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well ,septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet ofthefc1lowring:(a) buildingtoall lot lines,(b)buildingto center lineof road,(c)building 11 <br /> measurement to the ordinary hic It water mark of lake,stream, or river. 0 <br /> 4. If separate plans are submitted try an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 c N <br /> 1I z `a <br /> PLOT PLANPAC '� llyy„Sr J� Sefi I/G but O� V y 300.- P a <br /> I O <br /> ZCoQossaM11111oJ 11,gpo°� C J <br /> ,s^ �•59a m � <br /> o ' <br /> X © 5 tv er C <br /> T <br /> f �q' CO <br /> W <br /> t� — 7be/ <br /> 10 <br /> M 0 <br /> u I11ZQrOPok d n' �061 . <br /> O <br /> t <br /> yc r z <br /> 1 <br /> 0 421 4y r Ln <br /> o\110J►n <br /> > <br /> rn33 ItMa <br /> CONDITIONS OF PERMIT: < �' @ C g <br /> 1. DRIVEWAY MUST MEET DRIVE VAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> a f in: <br /> 2. REMOVAL OR CUTTING OF TF EES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — 333. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` !" n' c2i In <br /> 1 declare that this application(inclu(Ing any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct an complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «w T <br /> tion contained in this application(in Auding any accompanying schedule)and 1 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 1 am providing In this ap- <br /> plication.plication.I agree to peril county o icials charged with administering county ordinances or other authorized person to have Orr v « <br /> access to the above described premises at any reasonable time for the purpose of inspection. ,n <br /> i O <br /> SIGN HERE <br /> ( ' n re ofo or building contractor) �' (date) x <br /> i <br /> 8 ' <br /> ZONING ADMINISTRATOR ' OR I x <br /> $ M <br /> OWNSHIP PERMITS MAY BE REQUIRED o m <br /> $ 'o $ $ fA <br /> ew <br /> 0 <br />