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MA <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 E o <br /> APPLICATION FOR — LAND USE — PERMITS — _ <br /> m s <br /> FO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> orated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a C <br /> 3urnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ f <br /> regulations of the State of Wisconsin. w m V 1 <br /> ,/� L� /) Q to - 4 57-os4 s $ f <br /> JWNER NpruIA . APr E ��AA�Tj�� A UTNE^P1i.DINEry-�7n��S-6,k7-x1, 39 m m <br /> 4DDRESSiJ .'V�. 0 J�,�EC I�/ l 111 V e <br /> EMERGENCY/FIRE NUMBER / 1633 ROAD NAME NO. SHO ret <br /> ITL -13 'f l 33z, L/ 33/ss4/ S r3F(/RI S(Lc.) L <br />.EGAL DESCRIPTION (see tax receipt)pL,L' l 0700 DO SYAJ$ N� LAIL SNp,eE <br /> b 1 a LOT LO rs 10 61 // L <br /> CONTRACTOR 01gCk-5 &gZ)T4l ESS CONST/CIJCT'l OstJ, SN0- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING G4B&WACCESSORY STRUCTURE_ ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °c_ <br /> STRUCTURE/ADDITION USE: 61sKR1 ,< 3 LIW L/ / <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) o 0 <br /> 0 <br /> m <br /> 3 <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 (NEI) and Indicate North (N). <br /> r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 4 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -4 <br /> measurement to the ordinary high water mark of lake, stream,or river. Q <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 _ <br /> dated by the owner. () 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. sill ? <br /> 1A Z v� <br /> PLOT PLAN p <br /> /�CCrSS RofrO �` s <br /> Z$ <br /> ,� Ici of pooh CD (v}} 'RAF --A Z& <br /> 'IQ) <br /> t <br /> _, <br /> 1 ---F <br /> j �rar` D1 �yr Q Iio <br /> Q Lor It I Lar )D ' 1- 07- -f o" Orl� I <br /> I <br /> 1,O a a I r� V--C <br /> _- m <br /> $.� Iaaw z <br /> CONDITIONS OF PERMIT: Z Q IQ g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. , Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge <br /> Q ? i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. m <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•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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have - <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> i <br /> SIGN HER <br /> (a gnature of wn r or building o oI) _ a---. <br /> ZONING ADMINISTRATOR -` g <br /> � <br /> � At1G1994 <br /> WNSHIP PERMITS MAY BE REQUIRED IT <br /> I(', Sit <br /> t vmi <br />