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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0N�Co <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c -fl <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 3 n <br /> regulations of the State of Wisconsin. <br /> m � <br /> n O <br /> OWNER INA k4e S, 1V. R&A4 t,4 TELEPHONE 6/2/453 <br /> S o ' <br /> ADDRESS [? ld+G:/ ULCi6 W fy NOfLTe (�� C3 r�iU 3 �ZrI <br /> EMEEMBER /_T7//© ROAD NAME <br /> LEGA DESCRIPTION isee tax ceipt <br /> 56 z 46 bas tef v ai3 aha a �X Lisy /i r� aY/ l� U <br /> CONTRACTOR PF ,2So� �NST72ueTtof.1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE__ ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT_ SUBDIVISIONo ° <br /> n' ' 0 <br /> STRUCTURE/ADDITION USE: �OA46k FM fi18&PX--fj Y/6AJ,41 - 6 iSilt2. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> -V f,- <br /> 0 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). <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buiidingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signetl and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 11 a N <br /> 71 Z Q <br /> PLOT PLAN T NOrZru A o a <br /> ea <br /> y!!. �PPdox m a <br /> <— Z oo' — w <br /> N R 'ro F_ps� C <br /> N6` l <br /> �J N <br /> n_ <br /> r C' o <br /> O <br /> y <br /> N <br /> K -1 <br /> too <br /> 3tr I�Sr-D <br /> S7 F- <br /> ` (RPR.o / mi£� 2 am Qm D <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH.REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 7fl i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o O 2 O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o im <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. .n m er <br /> ' In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- id o p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o <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- a <br /> plication. I agree to emit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the v desc a at y reasonable time for the purpose of inspection. r 3 0 <br /> A N <br /> 3 <br /> M 0 <br /> 90 : <br /> SIGN HERE r-- ,n i <br /> (signature of owder or buildinc ptractort <br /> ZONING ADMINISTRATOR g E <br /> TOWNSHIP PERMITS MAY BE REQUIRE ^ 0 N N P N N N N m <br /> Dn�SirC) 000000000 <br />