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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m a <br /> APPLICATION FOR — LAND USE — PERMITS <br /> �. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described andv <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M Cc �. <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin., K�5�0�1.J /r lo1ltiI 433 -"-1 q P9 <br /> OWNER /lN � pH <br /> - o <br /> 349- 5377 <br /> ADDRESS 1Q2� Z <br /> M 1 <br /> EMERGENCY/FIRE NUMBER (l ROAD NAME G " <br /> v <br /> LEGAL DESCRIPTION (see tax receipt) Sz tc -r--31 I R 11C 64) <br /> CONTRACTOR J OHST*xz SES p—UGT C <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAG CCESSORY STRUCTURE_�DDITION p j <br /> 0 <br /> SANITARY PRIVY •FILLING ADING L17TLF- �PAAM�MPING UUIIT,y.,..— -'SUBDIVISION ? ° <br /> STRUCTURE/ADDITION USE: 411 ("lU^'tl�,•y/r i-g/j�LI EQ, � .�%17 IJ6TIIJ �eJ Gda Sy"d2R4f o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building 1A <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 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 o rn <br /> PLOT PLAN Z cv <br /> C °I ° F � <br /> W <br /> `I <br /> 0 rrj <br /> I u <br /> l/ 0 <br /> ay <br /> j1 I <br /> 1t' Q.f1f+X (NEf.L Z <br /> Haus 3d� <br /> R(v�k- \. <br /> M o c . ry d c a <br /> Z ' <br /> CONDITIONS OF PERMIT: N d C N o ic_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o= » ; m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, �'� ' b <br /> m' " C <br /> $ 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 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs rC. w m <br /> k .yE . <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �m vt <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i'•^'„$ m $ <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 countypRicials charged with administering county ordinances or other authorized person to have <br /> access to the v described pr m s at any reasonable time for the purpose of inspection. m $ <br /> T i A N <br /> M M P <br /> S CGQZ M <br /> SIGN HERE <br /> a <br /> (signet f owner building contractor) <br /> x <br /> ZONING ADMINISTRATOR <br /> N!A !A(n N fA T <br /> TOWNSHIP RMITS MAY BE REQUIRED N N p p m <br /> N <br /> m9n 888 8888uu) <br />