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N .9 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -i o2 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o m <br /> Burnett County land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and o <br /> regulations of the State of Wisconsin. c <br /> n £ <br /> OWNER ;O Frq Lt TELEPHONE 2 , m <br /> ADDRESS <br /> OQ <br /> 1 <br /> EMERGENCY/FIRE NUMBER Z�Z 1 �, ROADNAME OFF M t LLETZ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR M%2 -tzVr C pt"c <br /> TYPE OF PERMIT(S): DWELLI /BUILDING GARAGEIACCESS0 STRUCTURE ADDITION_K o <br /> n0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 �_ <br /> STRUCTURE/ADDITION USE: 1 5 Efl5[)N PO 2Cf-k ° o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o c <br /> m <br /> 1 <br /> r <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). ° <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 signed and O <br /> dated by the owner. C 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o N <br /> 7t Z a <br /> PLOT PLAN �Vr1�st,r Y a H. I <br /> i,�itt m a <br /> 13 G <br /> 1 1 ����.. oo C <br /> 13C <br /> b'+U �e^j <br /> X ISIS5� <br /> Is fro {j`,�,, IoG lR��L �l1� <br /> w <br /> 'U, IyD .S( s� � VAT` z <br /> r 9 o c m m nF m <br /> g3:s ZNo �eo ; <br /> CONDITIONS`6F�ERIOIR. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. q T <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n ,: <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'N - - m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S : , <br /> �; <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- yy!! m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- Zi s ut : p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i8 0 $ <br /> further accept all liability which may be a result of the County of Burnett relying an this information I am providing in this ap• <br /> plication.I agree to permit county officiaa - <br /> Is charged with administering county ordinances or other authorized person to have O <br /> access to the above described premises at any reasonable time for the purpose of inspection. T , : B - <br /> M i i m A <br /> I II (8/q Z- 8 ; <br /> SIGN HERE - - <br /> ( <br /> no re of o r Ilding contractor) (date) 8 i <br /> Fr <br /> ZONING ADMINISTRATOR /M� - - <br /> )1"ram�iN`= m <br /> TOWNSHIP PERMITS MAY BE REQUIRED w PPI N o o . m <br /> 88888888rn <br />