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Ok C , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS . f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work des oribed and Q i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirarr ants of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and th a laws and <br /> regulations of the State of Wisconsin. o <br /> N e <br /> C � <br /> LI,4Z,5jrOWNER y[ / Q TELEPHONE ��Z_ 73ga <br /> ADDRESS �O/� ID!L`- .S`T. Inv n-/7.ep W v') m <br /> EMERGENCY/FIRE NUMBER F/�. 7,��6 ROAD NAME 157 �/E11LYJ .eJIJE .�Cry/J <br /> ec <br /> LE D Mr /N O!TLOTS /•vp-2/ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION p <br /> SANITARY PRIVYo ::7FILLING/GRADING CAMPING UNIT SUBDIVISION o < <br /> J <br /> e <br /> STRUCTURE/ADDITION USE: 19/X/2/ JrwoKAC+6 EO o = � , <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v 3 <br /> 0 O <br /> m <br /> N <br /> Z <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). a <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,I.)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 CA <br /> dated by the owner. M a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> PLOT PLAN �SY ✓EI.LaW RI✓ ROAD o 'n <br /> Nw < <br /> N <br /> O <br /> C <br /> STORAGE AteK7.i4 J 1 <br /> SHED-N$ <br /> Io'x 11' i <br /> OVTNo W E-EB <br /> 4Sc4'—"rl �� 9 <br /> O � o <br /> J <br /> SreRA6E 0 <br /> SHED E8 WELL-f AG4TeD 2' FRo/h RTN m <br /> txI� <br /> lORO SIDS of GA&r/ <br /> I <br /> cgBIN-Eg i -� <br /> a 3o'x 3a' '� v <br /> No s,1vrw rarK Ar of rii»E Z <br /> i ND DRAW FIEtp Ar TN/S rME <br /> Iji <br /> YE�Dw <br /> k1 116k 9, S'g*-W ajo -0 <br /> D L <br /> CONDITIONS OF PERMIT: a wW.: Z �C m &m O 0 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c Q -f <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. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion 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.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 /> me <br /> _ m : <br /> pp e <br /> SIGN HERE �' 97J` <br /> (sign u of owner Ilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> `NNNN+NNNN+ �t <br /> TOWNSHIP PERMITS MAY BE REQUIRED o $ N N g m <br /> 88 $ $8 $ $8 a) <br />