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Burrett':ounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v0 �m o O <br /> APPLICATION FOR — LAND USE — PERMITS m s K <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v C <br /> locator(as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a $ <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. m <br /> u ,p <br /> OWNER rcl'lR� S TELEPHONE f <br /> cLxa�l ScLmelp� Gfz- e��-� a <br /> E / mUN <br /> ADDRESS .v <br /> 1 <br /> EMERGENCY/FIRE NUMBER �7ryN� ROAD NAME <br /> ��1��o(? ZSm Vor. b may@ aq rd 45in 6e ny 4 a1 <br /> LEGAL DESCRIPTION (see tax receipt) _ , ryLj n✓�n'!' Sic: 1 7''¢I�l� Q /S LtJ _ <br /> C <br /> CONTRACTOR G` r-ekR I1VUSl:. mey"N=__j <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n L) <br /> SANITARY PRIVYFILLING/Gw4DING CAMPING UNIT SUBDIVISION o ° <br /> 4 <br /> STRUCTURE/ADDITION USE: ►kA <br /> ticx� � 6 r � <br /> j '^'��( BA5e �OLMARrA-�r3aalr,edh ° C� <br /> N_(Home/Cabin;Commercial Business,Bedroom; Deck;etc.) 0 0 <br /> S } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) IC11 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). {�'0 1 <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). Cs 4 <br /> 9 c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v <br /> Tm <br /> rtc� 0 c <br /> PLOT PLAN o Place 0. bravoC/YlPatt cLtnc(ec "I{ea c�btr Wi°4cru <br /> h # ChufL� 1 ° n <br /> F1�e ale Valiax to� +k4 Cabin 0 <br /> Or Ct&CcAtOn J� K a <br /> 1 <br /> C/Ll�ll a � <br /> 0 ----------- <br /> � <br /> Cab i of 'ty 37' <br /> ° <br /> tsi o � <br /> N <br /> �Praor' �WriP�Cs ° <br /> g1-511 ^Len OvinSs'c <br /> ��. r gi Isoa�l K K <br /> Sh�nre Line <br /> -Cc�m S 2..'�a <br /> CONDITIONS OF PERMIT: o Z; c Q : <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. s N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r4" n t5 <br /> 5 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that 1 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 <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ $ <br /> of Burnett relying on this information I am in this ap <br /> funher accept all liability which may be a result of the County <br /> plication.1 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. T <br /> SIGN HERE ` » <br /> (signal wner or Ing contractor) <br /> S <br /> ZONING ADMINISTRATOR <br /> ' I ��t� «»«4' <br /> TOWNSHIP PERMITS MAY BE REQUIREDII <br /> +j,1 I X117 1 7 1%4 o N is U Nn'a 1S <br /> jr 888888',818 <br />