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ft60af <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 m f o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ 11- <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the Is Ns and _ U,) <br /> regulations of the State of Wisconsin. w m <br /> m <br /> OWNER TELEPHONE -Li .LESRrJ <br /> 1 Z9 (o 0 <br /> ADDRESS -7S-ZeA <br /> lZ vCk 1%1)VKviX:uJ I, W) 25-7 111 a V� <br /> EMERGENCY/FIRE NUMBERS ROAD NAME 1 L. �� <br /> LV—% 2 C* Gs u -2 $i GO '1 ?A 6c I�Ft i>r �� O <br /> LEGAL DESCRIPTION (see tau receipt) _ .T > _ S <br /> CONTRACTOR T <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> _ <br /> STRUCTURE/ADDITION USE: pi=GiL / �AiRLvCWR}� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z c <br /> 0 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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drairlfield (DF). <br /> 3. Show dimensions Infest of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 3 yr <br /> PLOT PLAN t t �,1 } c <br /> -` o n <br /> M o <br /> 40 <br /> I EB / <br /> 19 NEW W nk"M 18 ' <br /> o, <br /> I= <br /> �PkR) <br /> BA <br /> DP �O n <br /> 241 _ <br /> lomat Iv ' <br /> 2 <br /> M:E M <br /> m g,� fir S g- m <br /> 411Afh LA�L a $z:: aca8 ' K <br /> CONDITIONS OF PERMIT: < w [ `z .�, �' - 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a I Q � � —1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i =y' : 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ut : O m <br /> 2 '; t O <br /> I declare that this application(including any accompanying schedule)nes been examined by me and to the Oast of 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 informs- V,� " •+m tl'; T <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that hia infor- p <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 n this ap- <br /> plication.I 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 /> m ' i <br /> IS <br /> SIGN MERE '• ` « <br /> (al atu of owner or building contractor) f2 L do e1�` '', I I a' . <br /> LSi o i <br /> ZONING ADMINISTRATOR <br /> 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Z305 »Nn«« m <br /> _.o �� iS�N � m <br /> 888888 .88 fn <br />