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0/b <br /> Surmtl County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator S <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> m <br /> TO TAE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and Q v <br /> located as shown herein. The urWersigned agrees that all work shell be done in accordance with the requirerner IS of the <br /> Burnett Courtly Land Use Ordinance,sanitallon code, and with all other applicable Count'Ordinances and the I iws and $ <br /> regulations of the State of Wisconsin. m <br /> btZ-553-387 �i+) $ m O <br /> OWNER KATIt—, tllOF4=1-1/�fQ TELEPHONE (°IZ-603-9b30 (L)) m � <br /> 0 <br /> ADDRESS SZ-S GY�1r�t-LlL L�.� AIYMeJr-�T'FF �'•1N S�4'�F <br /> EMERGENCY/FIRE NUMBER SC-CWr 13'Qjl ROAD NAME PACwe T.)k <br /> PNZCJCL Wo-1 <br /> LEGAL DESCRIPTION (see tax receipt) Lv r-m,4t:t� aeiliG4 5. DIV. LOTS 'aZZ Z-3 g 21f ai-ocw. <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> � e7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o` <. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> p 0 <br /> m <br /> 3 <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 Nort I (N). <br /> 2. Show the location of the well (N),septic tank (ST),and drainfleld (DF). <br /> 3. Show dimensions In feet of thefollowing:(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. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be ail.ned and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. 11 o to <br /> PLOT PLAN o Z cf <br /> n_ <br /> C <br /> SEE-- P-)—r -c� 'iJ/e.-Pr.J /n)5 <br /> s <br /> �r- l�A.•-K.c�" Uel U-•e • IG <br /> CONDITIONS OF PERMIT: Q C 8 S �` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Z' V7 p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of Ill informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th this infor- p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin In this ap• ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authonzed pa in to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. mT <br /> Z M <br /> SIGN HERE <br /> p g to owner or contractors li <br /> ZONING ADMINIST ATOR ' ' $ ' '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED ] <br /> ' 8888$ $,88 ai <br /> I <br />