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61)c YAP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N : o c <br /> APPLICATION FOR — LAND USE — PERMITS — <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describedand 9 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementof the Oo <br /> Burnet[Courcy Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la and <br /> regulations of the State of Wisconsin. <br /> OWNER TELEPHONE �`�aJ yss-_�'s,z - E <br /> t yc{�E,/O J <br /> ADDRESS S9 rcl 241, (tet/• J� / /l%i J'5��� e <br /> EMERGENCY/FIRE NUMBER pts ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 6 <br /> �o'�` .3 lJOI{'ucSory v, <br /> 1 Y i'f <br /> CONTRACTOR �Lo� ✓�.^'Sf,N +— , ,I L f��� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p ^' <br /> 00 <br /> SANITARY PRIVY FILLING/GRADIN^^GL , 'J CAMPING UNIT SUBDIVISION ? o (G <br /> STRUCTURE/ADDITION USE: alp' d 7 ' J a / w o <br /> 0 <br /> (Home/Ca in;Commercial Business;Bedroom; Deck;etc.) _ <br /> 0 0 <br /> 0 <br /> m <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 thefollowing:(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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M U <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> PLOT PLAN 0 0 <br /> Sem �'f�-c/� �60 � 1'�Ct/✓ Ip N. <br /> 1 In fl� <br /> d e- 'r✓xcru.a_160 <br /> I � ' <br /> T H <br /> O <br /> O <br /> � � w <br /> b <br /> O y <br /> w <br /> 'V <br /> / z <br /> D <br /> S TLn j m <br /> 0 9S� gc 8leM <br /> CONDITIONS OF PERMIT: < =' Z 43 Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e e <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. log m <br /> (includingaccompanying y y °�0 E S'• C <br /> I declare that this application includin any schedule)has been examined b me and to the best of knowl- o <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- «a •+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a peril. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at an asonable time for the purpose of inspection. <br /> « <br /> SIGN HER OD . <br /> (sl u of owns o ullding con factor) (date) <br /> ZONING ADMINISTRATOR <br /> Z_ TOWNSHIP PERMITS MAY BE REQUIRED o I $N' Rm <br /> 8888 8 M <br />