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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 10 2 I o I o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> d 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 requirements of the n �Q <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. y m <br /> c nlI <br /> OWNER CAATELEPHONE 1 7©go o w 0 <br /> ADDRESS 58 �! Goc`nf,� AW A GGoylasfP/" Mrd" SIA%� �. �_ , <br /> EMERGENCY/FIRE NUMBER ROAD NAME ! U� <br /> LEGAL DESCRIPTION (see tax receipt) h/ /"'rte �, <br /> CONTRACTOR ["n //1 r I / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 Ort <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) (�j`j� Z o <br /> 11 m <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 (ST), and drainfiaid (DF). <br /> 3. Show dimensions infest 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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 cn <br /> �J Q1 � o <br /> PLOT PLAN a <br /> P <br /> y <br /> sNsp� �z�,., o^� 3 I`i-�/y 7 8, , 1 m <br /> out d`I-aka� Mf A-i- rJ'S� �iorr OFI�"� - FJ��t."c�/r►�7 bL Mo�pcl C 0 <br /> p4jrla U ti t,J-krY pi w <br /> New H �5' L <br /> t-tla h Out (J� <br /> i — 0 <br /> a, <br /> 30' 0 <br /> qO) l <br /> 60!' <br /> d.�ve <br /> Get 32 g 75 lr +Ie /� 1 <br /> L.'Ye Q Ji Conc�t�d^ivR� FGrn'�7' <br /> ILS-�"J1 _may <br /> '?r--11-4 orTr+lll c- �>afm <br /> )PEI Ivlh V /.,�� dk-( &YT`' 'v= e ?: C ' 3 <br /> CONDITIONS OF PERMIT: 'eL, /Up -0- rr-'K0 < m : z `B 3 to ; <br /> 4Q1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Day o F o � ' <br /> . REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N I A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, Wile— Ni0 N m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I (] v 8 <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- i iy, <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have i O N 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 b <br /> SIGN HERE <br /> «:- <br /> (sign of ownsr_or building contractor) ' _. date ... 14 <br /> ZONA'' ` ADMINISTRAT <br /> OR <br /> 8 : x: <br /> TOWNSHIP PERMITS MAY BE REOUIREO m <br /> U Soo 8 fmA <br /> M <br /> H <br /> O <br />