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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C <br /> APPLICATION FOR — LAND USE — PERMITS m _ — <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes = <br /> g by application for a Perms for the work described and � o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the $ � <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the awe and _ <br /> regulations of the State of Wisconsin. m m <br /> OWNERJTQ,pi{.(�� F� /UC L50 ,1 TELEPHONE 7��� 3a'-)�L��`.�(P o ` 0 <br /> ADDRESS �J � -rCJk1 rT �Ark1g1Ztk rS 5 �� �"� 7 '^ � <br /> EMERGENCY/FIRE NUMBER J7 a 7- 6/ IQ ROAD NAME <br /> C� <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) U <br /> ci' ro <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION_ o <br /> _ <br /> r <br /> STRUCTURE/ADDITION USE: L�K)/ /�ionJ (-,A44 — <br /> ^'R4RL c.r�rJ <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z o <br /> O 9 <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 arfthef011Owing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building -4 <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 slned and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE I$SLED. 7I 3 w <br /> PLOT PIAN a o a <br /> A C <br /> (jonL V:01 O� M , C <br /> _ <br /> a , <br /> a ( II In <br /> � II <br /> ocwc� �� rtc� C'oJ2i' ST{ lb�cl <br /> 1 <br /> 0 <br /> 0 <br /> IN <br /> o <br /> _ <br /> _ <br /> m <br /> v y <br /> III <br /> I <br /> Z <br /> 9-1 i I <br /> I f <br /> SII aMW,->>0 -0 <br /> m %'�'=. 5m m <br /> CONDITIONS OF PERMIT: c m g:�Z C g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m 8 Q i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i <br /> pNp i :0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ! �' Q S O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of ny knowl- E O : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- «$ - m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> motion 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 n this ap• <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to hwa O <br /> access to the described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> Q /& —aG - -74 <br /> (signature of owner or i Ing conic to (date) p <br /> ZONING ADMINISTRATOR f � / �. > i i i Y :tj <br /> '" Z1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Oo nm N 6 fn oN m <br /> 8 $ 888$ 88rn <br /> 0 <br />