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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 01 o a <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ra <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m . <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. w m <br /> w � <br /> OWNERS G O 7r L yN G I- 1E TELEPHONE <br /> O � <br /> m � <br /> ADDRESS y/3 8 COLIf4X AyE N N► PLS�Ni N SS y/ _ <br /> EMERGENCY/FIRE NUMBERROAD NAME5/lair L4/rc R�/ <br /> 713- ' 3,27 "1,A11A <br /> L o r/0 rrwaS"/P 3 7 '0V/ Rl'vtj-/bLt, <br /> LEGAL DESCRIPTION (see tax receipt)5 Py q!r L.,ityc sHon S Eer/OA7 3 end <br /> CONTRACTORPe L * 3 7e !B r 0(e 0 t 0 A <br /> S4; rRgDc L41r T-OWN5N//° <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION n 00 <br /> UU <br /> <. <br /> STRUCTURE/ADDITION USE: 6'9R/9 e / 5 Tp le'9 F' o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> 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). <br /> 2. Show the location of the well (W),septic tank (S1),and drainfield (DIF). o <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. 0 <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. o <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. O 0 a m <br /> PLOT PLAN z <br /> 0 o a <br /> (00 M <br /> EAR9 EE 55 t <br /> 38 <br /> 0 <br /> 0 <br /> URIiEW9y <br /> 3 <br /> 0 <br /> NOR rH o <br /> N <br /> m f r Y 6,15c/ ee/v r U` <br /> z <br /> y <br /> y OT /O <br /> as-c' <br /> PuBLlC Rc.9v <br /> 0o c m m n a 0 M <br /> m _ �� > > o n �m <br /> CONDITIONS OF PERMIT: SpinIr L/l'-V o m < ; 9: 00 =0 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 ,2 <br /> o F nT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 2 M <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �+� " <br /> o� � : O <br /> C <br /> gi In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. b 0 In <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- k <br /> tion contained in this application(including any accompanying schedule)and I 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 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 o N <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 g <br /> T V <br /> '7 — p p N <br /> SIGN HERE / � <br /> (signatur of own r building contractor) -- <br /> SF x <br /> ZONING ADMINISTRATOR T/M /-L.//N E Al --` <br /> x: <br /> TOWNSHIP PERMITS I iE REQUIRED a N 31 1992 u N o o b m <br /> JUl 88 �8888v, <br />