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0n (tb-;>'� <br /> att County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. — <br /> m o � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ^ m <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 ( � <br /> regwations of the State of Wisconsin. N o J \ <br /> c <br /> m <br /> /�' w <br /> OWNER 1 / ,e;d�i, TELEPHONE �e/p_/'Z gG� _3'3� m � <br /> ADDRESS 3/2 ll. N A4 N, 008'Itw <br /> t <br /> EMERGENCY/FIRE NUMBER fj I J0f1b.JIyE <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) See- ,G l T40 �(_R A, w Nakard TIi t� <br /> CONTRACTOR r• <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> w r " <br /> STRUCTURE/ADDITION USE: <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> O p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I C <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 drainfieid (DF). R <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. <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 a rn <br /> 11 Z Q <br /> PLOT PLAN o a <br /> c J <br /> M <br /> m <br /> -� Dn i uewu� m <br /> U D N <br /> / O <br /> J <br /> ' camson &'.A <br /> o <br /> To : <br /> ia'x ilo' � <br /> �lof line - 14.l� ,O Z <br /> �2) fest 1!r aF rood = QW, � <br /> I <br /> S3 �Dn0 <br /> 0, a m <br /> CONDITIONS OF PERMIT: S.: Z C g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISS CE. o £ TQ : "I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: : 9 <br /> _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u' : O O : m <br /> S ; E a E E C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- o : F: r <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all nforma- .w y>: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B 0 : t3 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 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 N <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> � � o <br /> m <br /> r <br /> SIGN HERE ,� <br /> (s' n ure of ow r uilding contractor) 1j j '"'. .'(date) <br /> ZONING ADMINISTRATOR <br /> NOV - kn : s - <br /> e'f!ra NNN N T <br /> 00 ( 000, m <br /> m m <br /> o b o o ' boo <br /> TOWNSHIP ERMITS MAY BER 11;!�t, '` 11 ^ 0 0 0 o S o 0 o rn <br />