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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a) To <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3. n <br /> regulations of the State of Wisconsin. H ° <br /> 406kf< -z22 o -I 2 / ,p <br /> OWNER /' Orr-C rY5 tN• O�R� TA=E r-/P if Z —S 7 / 'O O 3 U o O <br /> ADDRESS �O Q `iLS/V Err r�C , C r 6R 1j I l r . 55C/3 , <br /> EMERGENCY/FIRE NUMBER ROAD NAME Ce �r lot- nc <br /> LEGAL DESCRIPTION (see tax receipt) 1_/ <br /> Cs ,W, /t--' '�D C• q7 JA 0)-su <br /> T 1 <br /> CONTRACTOR 6 ,reJ/V Al L- Q J <br /> 5 CVS TR UC / [i G"�eU 37^l <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING X o__ CAMPING UNIT SUBDIVISION o ^ <br /> '^ r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> o ° <br /> v <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). <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 signetl and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> 11 Z <br /> PLOT PLAN rL OA5:t 5CE- ((PLAT MAP SK&TCp`/ /9�7"rE�'Ham, m o n <br /> C�n(x lJr�s v�C /l2 M• a <br /> 0060 <br /> MAY G <br /> I <br /> I) A-ll aretk o"'�7 / ll -t - -tz' <br /> 0 <br /> 3j NJ <br /> e,. <br /> tel/ IV `�r.1 T-i;hv le ScP.,�,��Q��.G>n.'�(j <br /> M <br /> Iag.mm <br /> e._ 33 <br /> CONDITIONS OF PERMIT: <br /> $ m: zoo <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a ' -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r I ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. °�' m <br /> I 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 I am responsible for the detail and accuracy of all informa- : «� «.: m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- G `. 8 a g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 O o <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. <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ; E O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r ; 3 0 <br /> A N <br /> SIGN HERE <br /> (at atu of owner Iding contractor) (date) <br /> op <br /> ZONING ADMINISTRATOR �' uul <br /> ! r 0 E <br /> Z11 0 <br /> `nh MN+Nd1Hxs -n <br /> TOWNSHIP PERMITS MAY BE REQUIRE {I II i ) E9 N � 8 1 m <br /> 00000000 N <br />