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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54372 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO T.JE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a ° <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. Cola- 939 m <br /> m <br /> OWNER �I, RS 11 1, ICsr—Yr��_l� TELEPHONE <br /> ADDRESS Q1'A1�0-`r7 7 r-6IY I)?tA/(�JWC+ r r G5CC7kti 4W QgXieyiU.F1 M iAw 1 <br /> 55113 <br /> EMERGENCY/FIRE NUMBER �O(�o ROAD NAME I I <br /> LEGAL DESCRIPTION (see tax receipt) E <br /> a ` <br /> CONTRACTOR DAVE' AtAwynD`1 fgeogy <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION u <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo <br /> IC <br /> —X— L w ') <br /> �/ <br /> STRUCTURE/ADDITION USE: ft t Oc7 a o —� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) P Z S <br /> 0 ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) DOI <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). 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. <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. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 u, <br /> Z or <br /> PLOT PLAN N o a <br /> C l � <br /> � <br /> r m <br /> v � <br /> o <br /> w sc — <br /> m <br /> o <br /> 0 Ma>o <br /> CONDITIONS OF PERMIT: a 5• c ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f� i ? S R <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N'• <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O 9m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 o : m L <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- "040 N m <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 <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> -n 3 <br /> Fi�_ m $ <br /> SIGN HERE <br /> (si to of owner Ildin contractor) (date) <br /> ZONING ADMINISTRATOR �E <br /> 1 4'. NiNH '7t <br /> TO PERMITS MAY BE REQUIRED ' o 8 o,f�,N� m <br /> .J wIn <br /> 8 8 8 8 8818'8 U)) <br />