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AA 1 <br /> Burnett pounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS m _ o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the aws and o <br /> regulations of the State of Wisconsin. a m <br /> I) !� ' 1 c m <br /> OWNER I)All t I�E}M r C )Z /� I�TELEPHONE / O <br /> ADDRESS C1 q0 ( �Q h ' U/ / �" 16 id rl '- f/J�7C L W j / i h r7 r m n <br /> JJ i I <br /> EMERGENCY/FIRE NUMBER " �O ROAD NAME 4n� �,� R O i 1 ) <br /> fcl i 'va3� Pc�H <br /> LEGAL DESCRIPTION (seetaxreceipt)Siji/D j�j •�/ j}Pjj�,S 140q-0 OU` CSG <br /> 0 - <br /> CONTRACTOR S'u g L J7 i r-( <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0- <br /> STRUCTURE/ADDITION USE: 444= v J <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 0 3 <br /> 0 <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 Noi th (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfieid (DF). ° <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,( )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. C) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, Z <br /> PLOT PLAN N �S WC i S' oWAr N - o S <br /> A p ® -T-(?6 M m Cf•rl't o lily - ( D fn �--1 <br /> o � cl <br /> r1, 1 s r- ti c m i y v � vn 4y I+ u c 0 <br /> n Al So fill <br /> N <br /> N I 1 <br /> \\ 0 <br /> r O <br /> -1 <br /> w <br /> 30 a8 ' COKJA%)rus O's� p rt ^ / <br /> R oO '�) /Vo <br /> o� v"e eXc it�� <br /> S 11 I r /w cn n <br /> 3� �JT u �uu� �Vf0c D Oc�W iDiaOT <br /> Agmrr <br /> D � w <br /> LArOVCA+� (� NQ. Z C <br /> CONDITIONS OF PERMIT: p o £S a Ka g2 3 <br /> S.: . 9,2 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 210 i i 7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r N 2 R <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ <br /> C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the bestof my knowl- SLJ o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy, fall informa- " 8 m d• A <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize hat this infor- ,�-. $ C <br /> matlon I am Providing will be relied upon by the County of Burnett Wisconsin in determining whether to ias e a permit. I $1a $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am provid rip in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized P inson to have m <br /> access to the above ds promiaea at any reasonable time for the purpose of inspection. <br /> SIGN HERE _ <br /> (elq t re of wne ildlnq contractor) <br /> ZONING ADMINISTRATOR - 1310 <br /> 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 1888888884 <br />