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J . I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0) + z <br /> m f o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONI ADMINISTRATOR:The undersigned here makes m <br /> g by application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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, o /' <br /> io m <br /> N � <br /> C <br /> m r <br /> OWNER ..S;.AN nIE /YJ . `�U� TELEPHONE � /',Z _ (� Lf CF..) '�J� G, o J O•� <br /> ADDRESS 13 / ? ZAFOND A ✓E STJ m m <br /> PAUL , MYy 5s-1 614 <br /> EMERGENCY/FIRE NUMBER <br /> /S7ROAD NAME r<.UAO <br /> LEGAL DESCRIPTION (see tax receipt) HISToRy V 397 P `f!i, c10/Tg6/p,14 vV Acr1Es • 7190 n <br /> PCL# 46. r4 /0 03910 Pct (oy , ,-r Z K r , 7 ) <br /> CONTRACTOR <br /> ..Jim SKY NA.WK Coh15TKtl(2 T)0N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: N D/hE C A 13I n/ H <br /> o 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z - <br /> 0 0 '- <br /> 0 <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 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 atgned and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 a rn <br /> PLOT PLAN <br /> M w <br /> o <br /> M _ <br /> U <br /> T T•J -1 <br /> O <br /> CO x <br /> i <br /> _ s <br /> V aAi{lioi ('eN<Jirr r <br /> In <br /> CONDITIONS OF PERMIT: o' m :z <br /> C . 0'c 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERISSUANCE. Z m o ' Z m Q n + <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o F = : T ^ ; !i! M <br /> In <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. tnn i G) L In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowk m <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa. w m v, : O <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. 1 ' " $ m 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- w <br /> plication. I agree to per county officials charged with atlministering county ordinances or other authorized person to haveO Pp <br /> access to the above tlptacribed premises at any reasonable time for the purpose of inspection. : m 8 g <br /> -n i i v A m <br /> SIGN HERE --�_. J ..n:xh �_.. ✓ C/X y, . <br /> N <br /> (signaturelof owner or Duildi coral o �/i (date] [ , <br /> ZONING ADMINISTRATOR. !! �f x A <br /> %i •� q € 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED a o o 0¢5 UM <br /> 888888818rmn <br />