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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 3 0 a <br /> APPLICATIOWF(AR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Psrmft for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 n <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances <br /> and the laws and _ o <br /> regulations of the State of Wisconsin. C Swt- o T w <br /> g 55� 13f3 <br /> 'IOS— A o <br /> a f <br /> OWNER TELEPHONE m <br /> m <br /> ADDRESS H�y _ ��//£; �� ,�y/YMET T' o.t wT✓ <br /> � I / <br /> EMERGENCY/FIRE NUMBER a ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) G 6E f] �/{ �f-/E!� <br /> V <br /> .T.SEX T-A/ ? <br /> CONTRACTOR '4 L°H 'e E/EcT,e I CQ L X P�4M f3IfyG <br /> y SFS <br /> TYPE OF PERMIT(S): DWELLING/BUILDING <br /> GaBAGE/ACCESSORY STRUCTURE ADDITION ADDITION o <br /> n 0 <br /> SANITARY PRIWLLING/GRADING CAMPING UNIT SUBDIVISION o �. <br /> o <br /> STRUCTURE/ADDITION USE: trdV v a, <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o Do <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). R <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -q <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 signed and 2 0 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED F ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z <br /> PLOT PI11,14— 'dal r pwo 0 0 n <br /> p M <br /> own m � <br /> Q <br /> GAR <br /> ti G Rc y <br /> e <br /> r ® o <br /> N <br /> � o <br /> pi O <br /> t Z <br /> i�,E NO R7If E,nr QuARTa R 0,1- T/F.< n'eFTy a <br /> V <br /> E-A 6T Quq.PTfl; cj- San <br /> sF- 3$ nio RT.v, of �a A'sE /S�CJE3T <br /> SURA-E'TT' Co vvTJ' UJ- <br /> g)y.j0 �!j A c>> m D a o m <br /> F <br /> CONDITIONS OF PERMIT: 3 0 £ ZM <br /> .z : : -{ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIREME (THIN 60 DAYS OF PERMIT ISSUANCE. u _N: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Qt in : <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o �. p <br /> o : C <br /> application(including an accompanyingschedule)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� m n ; m <br /> application(including an accompanyingschedule and I further declare that I recognize that this infor- Y o B b <br /> tion contained in this app g Y ) �; ; o o : <br /> Mallon 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 ; 3 <br /> access to the above described is at any reasonable time for rpose of Inspection. T : v <br /> m m <br /> SIGN HE <br /> Is n ure of o r or building contractor) t x E E <br /> ZONING ADMINISTRATOR ' <br /> 6.- <br /> TOWNSHIP PERMITS MAY BE REQUIRED SEP 29 <br /> 00000$ 00000 <br />