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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator J5 m E c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m F <br /> 9 by application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. o <br /> w m <br /> w <br /> OWNER TELEPHONE L-7 LyCQ Z S L3 o E <br /> ADDRESS 1 "74 Z / Lt's 5� �l/'Q.LiJ RiL�mon�1 + r_� )LLs_�. X401 �n I <br /> EMERGENCY/FIRE NUMBER ROAD NAME Lr R ut1J <br /> O ' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Seri, L14ctc 'eA 6gg <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 1L GARAGE/ACCESSORY STRUCTURE L/" ADDITION 1 0 <br /> SANo <br /> SANITARY PRIVY CAMPING UNIT SUBDIVISION <br /> �ed o�fj p <br /> V "L f 4,N V m r <br /> STRUCTURE/ADDITION USE: I-(�,; b,n o 0 <br /> (Nome/Ca in;Commercial Business;Bedroom;m;04 ck;etc.) Z v <br /> 0 o T <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 6 '� <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 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 2 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in 3 y <br /> PLOT PLA o g <br /> m <br /> 10 <br /> _ V1 <br /> W <br /> KIN <br /> rj <br /> 1 <br /> m <br /> tctv <br /> Z <br /> L13 K _ 94)0�A <br /> A age 0. S. a � m <br /> 5 z <br /> CONDITIONS PERMIT: <br /> Co 5 m K <br /> 1. DRIVEWAY ST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E L S z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -' v! M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �+� <br /> g Ci <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 3: `0 m i 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 /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a Kermit. 1 ! 8 a 8 ; <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• q! <br /> plication. 1 agree to permit county officials 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. 1 88 <br /> N <br /> 0 <br /> SIGN HERE /y /- 92 <br /> (signature ofr or din e r r) (dot � <br /> ZONING ADMINISTRATOR X E H E <br /> TO SHIP PERMITS MAYBE REOUIREb'` 2 ,,,' 'I', 888 <br /> po N o ,p m <br />