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Burnett County 7410 Co. Rd K, No. 102, Siren, WI 54872 Office of Zoning Administrator Q / - o Z <br /> APP ATION FOR — LAND USE — PERMITS '" 3. 3 <br /> o <br /> TO THE ZONING ADMINIST R:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable CountyOrdinances and the law and 3 n <br /> regulations of the State of Wisconsin. — <br /> e C>, I mawN I�6 W , c-�Id� un N d <br /> OWNER m '�J 1 M O <br /> //la NA., (} Uce SUutn41\- TELEPHONE a f <br /> / EE77"�^VC c r , <br /> ADDRESS a I �� Lre A-1 A-1 Us <br /> EMERGENCY/FIRE NUMBER �� ROAD NAME -K <br /> LEGAL DESCRIPTION (see tax receipt) �U� I Uv I ) y �� l <br /> ly <br /> CONTRACTOR C`�/ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE Y ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT_ SUBDIVISION ° <br /> n l //�� ��fJ� // /I-- ��.p�� o < <br /> STRUCTURE/ADDITION USE: ` )}MaIna �y/ `f' `►�OI'T4K1tk. 'W ee,- /-_) rX�.6 0 ° <br /> (Home/ abi Commercial Business; Bedroom; Deck;etc.) Z T <br /> o ° <br /> 0 <br /> M <br /> a <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). I R <br /> 3. Show dimensions in feet ofthefollowing:(a) building to 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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. M o y <br /> PLOT PLAN em SwrZ MA � o a <br /> `S <br /> 5. <br /> Sem �li.E �� So- 1 Tesf. � <br /> w�l l 6e o.ti I--°� Mo rw� �,,, <br /> L-a l be- 5-h"l I W <br /> lyetr ( l'aMPI"q ev1 � <br /> �► �5 o o <br /> See Peft-t It qlo( Fee" � <br /> 0 <br /> v � <br /> ® {2 d3OULl( S1f�y )w t wwp ^ tt^ u z <br /> ny, oro wt L �J I <br /> �N�>` Cvf,�l� be subrJtt,.�t>�( o-s sen <br /> �r 06LP70 � a only RNy <br /> — Xl � cSi (c- tine- Opal u <br /> µµ / r-2�wre m o in ° m m 0 n <br /> (elle/^ UA-Ii eAc O✓- LISE' m 16.'2 m n N a 'a M <br /> CONDITIONS OF PERMIT: fD m Q o ,o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z f° a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o m ' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" i O O <br /> 'm C <br /> 8 € o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I 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 permit. I $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing it this ap- yy�� <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O ,cin o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 s : <br /> T v A a <br /> M M A <br /> M p <br /> SIGN HERE <br /> (si t re ofo r or Duildin LI XV_ (date) . � x <br /> rr ` <br /> ZONING ADMINISTRATOR $ ' <br /> TOWNSHIP PERM $ A�V! 1UID j SEP 92 `cZ" 0 0 0 9 m <br /> 8888 888 (mn <br />