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Burnett County 7410 Cc. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3_ <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and Q w <br /> located as shown herein. Th i undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Or inance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. N m U 1 <br /> c '? <br /> m <br /> OWNERTELEPHONE gl5_ i0sZZZ8 F <br /> o 0 <br /> n m '° <br /> ADDRESS 7(o3 I'Eli ST. IAAPr(LSt:, I0.E5 1L - (P13t-11 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME L i LLLJ L K/ <br /> • � I <br /> LEGAL DESCRIPTION (see tax receipt) 1 GQ i_L. L P w— <br /> CONTRACTOR KO(ZLELi $ C.U$—10m CAR.PUN-T I 1 a-N t: - <br /> TYPE OF PERMIT(S): DWELLI /BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n <br /> SANITARY PRIVYo <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: E D2C7G�r'h o' ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z v <br /> 0 0 <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 drainfieid (DF). <br /> 3. Show dimensions in feet 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. tN� <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. O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATI BEFORE A PERMIT CAN BE ISSUED. 7I o rn <br /> c <br /> PLOT PLAN n o n <br /> Lt LL C 0 <br /> to Z <br /> } <br /> N ,lt�(0 30 <br /> ( 4- pi< P�a o = <br /> C <br /> �Itp� <br /> Z <br /> prUGfr7Gon 01'2 111 <br /> from S Lrif- ,,..e 4- L/01�f- <br /> v <br /> FWJM r Pic Lt � In{ $ D 6.'2 6 . m om <br /> CONDITIONS OF PERMIT: y. -Z2 CS$ � i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� - --I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHO LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N: Q 2 m <br /> o : D <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl- o ! C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- u.ro M <br /> tion contained in this applica m <br /> ion(including any accompanying schedule)and I further declare that I recognize that this int B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether[o issue a permit. 1 $'$ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap. <br /> plication. I agree to permit co my officials charged with administering county ordinances or other authorized person to have O N v <br /> access to the above described9 <br /> premises at any reasonable time for the purpose of inspection. 3 b m <br /> -nAA <br /> m m <br /> SIGN HERE �— I I Z 'S <br /> ( i atu of owner or u contractor) -� tb H ' <br /> _t ; <br /> ZONING ADMINISTRATOR <br /> N+N N W N N M J T <br /> TOWNSHIP PERMITS MAY BE REQUIRED i �I AM R ( o v p m <br /> o000000om <br /> �t�•�.r �pP It� t� �r rrgtiy� � �i"°�°1���---L, <br />