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Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator o' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 's <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and g' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 $ <br /> Burnett Courcy Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m o I <br /> w m_ <br /> / �7 / ° O <br /> OWNER /1N .��g/V 1 ��T L� NE lS� 12 �/ 9:23On5— <br /> ADDRESS !� I •d �/�/'�$Y�Ir D CIV L✓O / 16 (j 1✓N/J /'! AV <br /> EMERGENCY/FIRE NUMBER ROAD NAME ���.� A M + ��. Z <br /> /� <br /> r/� <br /> LEGAL DESCRIPTION (see tax receipt) 94 W A O A //d — 1 <br /> CONTRACTOR S Lc LfZ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <- <br /> ,n• ^ _ o ° <br /> STRUCTURE/ADDrrION USE: f N!4/ 2 e 2 0 <br /> (Home/Cabi�mercial Business; Bedroom;Deck;etc.) a o <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 drainfleld (DIF). ° <br /> 3. Show dimensions In feet of the following:(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. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. Q <br /> NOTE; BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v <br /> PLOT PLAN P <br /> A "e r M <br /> i <br /> I I <br /> FOY C <br /> i ldo <br /> � I % Ib„ <br /> Nie/ 1tt1� �, I <br /> i <br /> !. r s <br /> PpoeN <br /> 10 C/AP✓r N m <br /> i <br /> ? ) I� <br /> � z <br /> I <br /> fl 'run <br /> ONDITIONS OF PERMIT: a 3. <br /> .-DRfr'EWAY MUST MEET DRIVEWAY WIDTH ' .:CIUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E i i 'z inE <br /> 2. REMOVAL OR CUTTING ov TQrES AND �EJETATION IS RESTRICTED ALONG SHORELINE. "" <br /> 3. NO GRADING OR SHORELAND ALTE11 rIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '• r" ' 15 <br /> $ �E : i C <br /> 1 declare that this application(Including any socompanying schedule)has been examined by me and to the best of my knowl- S E m <br /> edge and belief It Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs- <br /> lion contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Infor• i 8 <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> $g$ E <br /> further accept all liability which may be a result of the County of Burnett relying on this Information 1 am providing In thla ap- <br /> plication.1 agree to permit county officials(hergW with administering county ordinances or other authorized person to have k <br /> access to the above de rlbed prem) reasonable time for the purpose of Inspection. <br /> .�'1 <br /> BION HERE dalel...� ` Nio <br /> (sign ure 1 owrer or Ing contractor) (— E <br /> e i <br /> ZONING ADMINI TRATOR ` M '• <br /> —_._. $ 8 $�$ �w <br /> TOWNZNIP PE MITS MAY BE REQUIRED <br /> N <br /> 0 <br />