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f / cziy�Lpi <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (a v -t z <br /> APPLICATION FOR — LAND USE — PERMITS . >E <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° r \ <br /> Ig by application for r Permit for the work described and v m U <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremerlds of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicablemy Ordinances and the laws and w <br /> regulations of the State of Wisconsin. p� <br /> U L�xf'�f C S , A(�_1, mnt z5TJ <br /> OWNER I �-{ TELEPHONE <br /> m FAL-Ln h "1q T" <br /> ADDRESS piSntSU LA sleEj ` i � <br /> EMERGENCY/FIRE NUMBER �[-�Qof j ROAD NAME tm 1 r�u <br /> LEGAL DESCRIPTION (seetexreceipt) a -( t 1- 1 1 i <br /> � r <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> c1 L <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION - o <br /> o ` ) <br /> t PI) <br /> �-� <br /> STRUCTURE/ADDITION USE: _ <��-[�• AI PI)PC,H <br /> (Home, abin Commercial Business;Bedroom;Deck;etc.) Z <br /> O o <br /> 0 <br /> m <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 Nort10 (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)I I building .4 <br /> measurement to the ordinary high water mark of lake,stream,or river. 1 0 <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. '11, 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAID FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE tq�UED. 1A o m <br /> PLOT PLAN Ac a <br /> I <br /> M <br /> on <br /> Q- 0 � <br /> 1,C n i <br /> m le y P��prcTy 14------------ <br /> o .nt <br /> bc <br /> N <br /> IN 1J`J <br /> m <br /> �1\sill/ /'J 2 <br /> trEps fC� I <br /> ac <br /> ll QnQn1 Shc-BeNSrGI¢S/a"�"u 0✓�' <br /> Co,�plaf.,t� �todPta­- 6zlu e k,�il sLR�� ti' <br /> p ��1g 9 am m <br /> CONDITIONS OF PERMIT: �;:.; p 1T E. s_ 1 ,5 1 3 F-t O o\ U e Lf K g g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <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. Wf ,r"n i i o g, fn <br /> p iQ <br /> wl; O <br /> 1 declare that lois application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: C <br /> ed and belief it is true,correct and complete.I acknowledge that I am <br /> 1>e p g responsible for the detail and accuracy of all informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize thathis infor- E 8 <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 II this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized peraoh to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m o . <br /> w <br /> SIGN HERE 0 Q^ �'- 3 O •- i� < � E <br /> (s n u f owner o Ing contractor 1 <br /> (date N <br /> 1 <br /> i <br /> ZONING ADMINISTRATOR $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED )o N N g N N N$ m <br /> 88888888 ai <br /> r <br />