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Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 $ <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. H m V <br /> N N <br /> y C 1� <br /> OWNER �,:.•> �<'/S$IAn61r, TELEPHONE o ^^' f <br /> idv'/ ( / / C m m <br /> ADDRESS D 7C! � //1 C/>V.' C j ✓el& �;h t7t-r rL� Lni� Se/Y �O � V.) <br /> I <br /> EMERGENCY/FIRE NUMBER 'jL;Y^.tROAD NAME � r <br /> LEGAL DESCRIPTION ( receipt) <br /> tax t <br /> ) <br /> 7� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o ±� <br /> n o0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o , <br /> STRUCTURE/ADDITION USE: 9Q rv�.(,. W IT h VL1 Y@�" C� 'rY C�1 '��'jZ(� ��.{� i1Y� 0 4 <br /> (Home/Cabin;Commercial BusinesSJBedroom;Deck;etc.) _ <br /> 0 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 (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 of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building O <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 signed and 4 <br /> dated by the owner. O O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> PLOT PLAN � o n <br /> a of , n <br /> pri,ll iS cr 01 ao j iN to pJ 0 <br /> All,� 1 8 <br /> 'Sh�Pfu�j / H ) <br /> �0+- 3i m N <br /> Al 2y ?z (j 1 <br /> 0 <br /> cr Nu8 u- <br /> 7/7 <br /> n <br /> , icNc Z <br /> / 3r fr3 W <br /> Prop <br /> CONDITIONS OF PERMIT. E z C o 3 <br /> DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F - T� <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -n = i m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m OC <br /> 8 c <br /> o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o `D i3 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 I w m to 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation <br /> I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g 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 permit county officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> In 9 A <br /> N <br /> �- <br /> SIGNHEREHERE 30 <br /> (signature of owner or ' <br /> f el o : o, <br /> ZONING ADMINISTRATOR L "" 8 <br /> H i i <br /> TOWNSH PERMITS MAY BE REQUIRED OCT — 1 1992 <br /> 88888 <br />