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Burnett CWnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admidistrator In - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work dost iboCled and � m f/V <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem ms of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable Count'Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w m <br /> g <br /> SLA <br /> 41? <br /> n O <br /> OWNER -y�o SLA(RA mVZ.-L-C TELEPHONE �p��- y?7 Il (O f <br /> O = <br /> m � <br /> ADDRESS I X P 1 1�.7 ood Qrt t d St �t ?Au1_ M U, <br /> k <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Jir 10, 9 v Low 7 csm y P os— <br /> 'j 1sar jL <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY__DL PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> _ <br /> �aninl �ls.�v-P.id �tOM� N r <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 1 <br /> o � � n <br /> a } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) � �f <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). '��'' 0- <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,( )building- IN Il/� <br /> measurement to the ordinary high water mark of lake, stream,or river. I�[_ <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be igned and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a ur <br /> m 11 Z Q <br /> PLOT PLAN ✓r 1 S�'� "Lim () <br /> In N <br /> �t7s'a�f . �Il <br /> Ap*ao <br /> Ido' /J�1 , <br /> Ap N m <br /> B �v <br /> N <br /> lopp M �0, O <br /> ^rr <br /> ✓1 - <br /> w ¢ a <br /> Q Icy <br /> lr ` I \aw <br /> C �nl R^o <br /> mLL Fce jAsorV SOIL TGSi' 1S T Lo W <br /> �^i5 e � 6. m <br /> 0orlE f� v 3)2..g rr <br /> CONDITIONS OF PERMIT: &35� 7 0 < H': 'z C`B <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 8 31 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. to <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <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 ofall informs- N N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize t et this in $ B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to iso e a permit. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providi rig in this ap <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to hav O: C) <br /> access to the above described promisee at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> AN 3 1W <br /> (signature of own r r idin o tractor) (date <br /> ZONING ADMINISTRATOR <br /> ��' � N N M r- 8 <br /> TOWNS IP PERMITS MAY BE REQUIRED `'— _-1— --- �' " 1� rt8 IT <br />