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Bumett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator 5a ; " o <br /> APPLICATION FOR — LAND USE — PERMITS 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a d <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and - <br /> o <br /> regulations of the State of Wisconsin. m <br /> DA PJ �, 2�stad ° <br /> OWNER <br /> Digo�fiat+q .J TELEPHONE S�9- �l3aal m �" <br /> ADDRESS /ya95 39T/ Avr. Al P141t 4fi / Al Ss4y9 e <br /> EMERGENCY/FIRE NUMBER' /�'1� ^4 /�O - of , ROADNAME �R i! <br /> LEGAL DESCRIPTION (see tax <br /> ice( 7pt) v <br /> CONTRACTOR 56 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/A96666eW STRUCTURE_ ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTUREADDITION USE: �/ � TJTIO` Bfc ' D�S�t o e r <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) OZ a <br /> 0 <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 drainf laid (DF). I ° <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building A <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <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 <br /> NOTE: BUILDjf�UCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o m <br /> 1A Z v <br /> PLOT P A P n l <br /> N cl <br /> a <br /> r <br /> 1-7 <br /> 1 N <br /> O <br /> O ^III \moi\J <br /> )50 <br /> r Z <br /> 3 o p +1 fi As4 rl " N0 INS[G�C le i <br /> oVL�-v 13 +d, <br /> �Z 'sz �gg� 3 <br /> CON IONS OF PERMIT <br /> 1. D VEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. y: x <br /> 2. R MOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. SIT <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4¢ <br /> I declare that this application(including any accompanying Schedule)has been examined by me and to the best of my knowl- i 3 E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- fie, fr <br /> lion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Infor- <br /> motion I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may M•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 pe <br /> reon to have Y <br /> access to the ftvo described promises at any reasonable time for the purpose of Instion. 4 <br /> SIGN HERE L (dtle) <br /> (signal 01 ner or bulldln ontractor) <br /> i <br /> ZONING ADMINISTRATOR ' : 8 : <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 9 is I <br /> 8888 8 06 <br />