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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m - o to <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and F0m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the CO <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and o- <br /> regulations of the State of Wisconsin. /L \ H m <br /> OWNER iJ I2 U C� �ENSo N I p L ct �� TELEPHONE �j(Z l 3 79_p �*77 n m F <br /> / o <br /> ADDRESS <br /> ��? Sr <br /> NORW NErb(F e a 9v76 <br /> EMERGENCY/FIRE NUMBER Smuruw Esr ijErsgpoR 29/6)2 ROAD NAME Pf RDUN S <br /> LEGAL DESCRIPTION (see tax receipt) Lmr e?9 ) P/I/Ek 6'fl Abp* 0'€'f-e' Z smrP 1 �5 <br /> CONTRACTOR �� <br /> C6 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY ('� FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: 9n2 kIQG, /t m i SR!/n/a o' o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z v <br /> 0 ° <br /> v <br /> m <br /> 3 <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 signed and <br /> dated by the owner. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on v N <br /> c <br /> PLOT PLAN Z <br /> l � rqrrRc 6(0) m <br /> J / 2 f1I Q_ J m i <br /> v <br /> W <br /> n <br /> o <br /> 0 <br /> O <br /> m <br /> O ti <br /> N_ <br /> n <br /> Z <br /> Z <br /> m O C 2 m m n d g m <br /> 0 . 0 ° Q p m m <br /> CONDITIONS OF PERMIT: - v N. ,Z C o 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F -12 i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ^ : ro ,o,, : C: <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-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. 1 $ m 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in thisa - <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O 0 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ iQ <br /> m 3 A x <br /> V N , <br /> � lY qz > . , <br /> SIGN HERE <br /> (signature of wilding co ort - Idatet [ s <br /> o : <br /> ZONING ADMINISTRATOR _ $ <br /> T NSHIP PERMITS MAY BE REQUIRED AUG 1 41992m m <br /> i P P O N 8 8 . <br /> 108888 $ $ $ ai <br />