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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Parma for the work cle <br /> sci iced and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme rits of the m c <br /> Burnett Courtly Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. H m <br /> w eD <br /> c <br /> OWNER TELEPHONE <br /> t> tiD RR�un� <br /> ADDRESSNU Ell v `f7'7 10 6 o R 5-Zl 83 <br /> EMERGENCY/FIRE NUMBER ROAD NA 6l RC-1rC- Lqt"W/Q 11- <br /> LEGAL DESCRIPTION (see tax receipt) G �O QLK ep^ r,/V4-V/ <br /> GK{ 1J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING- GARAGE/ACCESSORY STRUCTURE ADDITION p � <br /> n <br /> SANITARY PRIVYo FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o - _ <br /> N <br /> STRUCTURE/ADDITION USE: IJ <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> o v <br /> m <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 Norl h (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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and 9 <br /> dated by the owner. O c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED.. on a y <br /> PLOT PLAN419 D R NrL1 f`1 N o a <br /> - - A <br /> III <br /> �7CA) <br /> N <br /> i JeAp%N 9-) o <br /> ��a 6 5 � <br /> r <br /> 91 C ?� <br /> q1tto/ <br /> a <br /> 1 <br /> N9, �L` �„ <br /> 8 <br /> E 5T IN'�,-�� Se Se<cU�bl f 4)(60 <br /> Z <br /> Si FK-iCP_�GA� 7RAl� � LvMBi�' <br /> IN <br /> N8� 14P/41-1U14) <br /> qAJ � <br /> PerY <br /> TnSic�t (✓a 1- ua) <br /> kG 't <br /> BL AcKfifAR 11CRFS g SOTM.M�'�k�'f m <br /> FL - a e m 33 <br /> CONDITIONS OF PERMIT: C)ij �H ? ?. ,z C 8 g 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ �_ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` to: E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn : V7 i RI <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl O P E C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- " 40m a m <br /> tion contained in this application(including any accompanying schedule)and 1 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 o <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> op <br /> SIGN HERE <br /> (sig u e ofo r or building contractor) (date) �€ E <br /> i <br /> ZONING ADMINISTRATOR Irl@ ? i 8 <br /> « N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED a �, <br /> $ 888 <br /> l bon I 4 �o-Gly <br />