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Burne't County 7410 Co. Rd. K, No. 1102, Siren, WI 54872 Office of Zoning Administrator U - c o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m oci <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> c <br /> ^r� 1, p m O <br /> OWNER Z� CNP.R� Aum 1<1? -V�*l _3�IZ LEPHONE <br /> 1p I = m 1 <br /> ADDRESS ,Q,54 Z'i AS\ CoyrR Ro Rt�, r )1.rtP MN 5511D <br /> EMERGENCY/FIRE NUMBER ROADNAMECL Utfi 1' HUJ�( A <br /> Ll7r 3F <br /> PGet2T�Fic=�? S•.R`f %Y �4A� %r-1015 <br /> LEGAL DESCRIPTION (see tax receipt)=a$.3 CSRi �5 i�co 12AeD ty o't CSN--', <br /> ,=p t3 rJ6♦ <br /> CONTRACTOR Co�,4T`1 W`SC.GQSrJ ru:GP114.a� irl C �SLN1•i6?4 l..vr ->s1prSGciYON cliyr <br /> x J yQ N('r�2TN l Iii�bE. 15 lii�.:> -ILIJ tJ li TlaGt:,�D+S. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY PRIVY XFILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> m r <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) Z vo <br /> o a <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DIF). <br /> 3. Show dimensions infeet of the following:(a)bulldingto 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 signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 9 3 rn <br /> PLOT PLAN SCALF ' J" n APPA. 45 Irr o n <br /> tAry ` OT a Boz �* a c <br /> FT. <br /> `'t 1SI Ills <br /> m � <br /> ( <br /> o � <br /> oC <br /> o N <br /> 0 <br /> 0 <br /> `H K• o <br /> 35 FT � <br /> TRW V <br /> 0 <br /> I y <br /> 2 <br /> uNPLA-T'T EZ <br /> PINE LAKE g a0 am m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F O i E ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 9 <br /> H <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u' 32 i ID <br /> $ L C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 1 o: i f <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- e'm n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- r v a1 0 : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $'i ; $ <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 i i O N p <br /> r <br /> access to the above described premises at any reasonable time for the purpose of inspection ,\ -, :?mTm,':i : f 0 yp$ , <br /> SIGN HERE1AAM 'm Lo' <br /> i i .'B E <br /> (si at of owner ilding eonVactod Wei , E �' E E <br /> 0 <br /> ZONING ADMINISTRATOR TOW ` <br /> NSHIP PE ITS MAY BE REQUIRED m u N <br /> m <br /> o $ $ $ $ $ N <br />