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Burnett Co u y 410 0. Rd K, No. 102, Siren, WI 54872 Office of Zoning Administrator m mo <br /> AP ATION FOR — LAND USE — PERMITS E <br /> TO THE ZONING ADMINI R:The undersigned hereby makes application for a Permit for the work described and 'Z w <br /> located as shown herein. e u dersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use rdinance,Sanitation Code, and with all other applicable County Ordinances and the la and <br /> regulations of the State of isconsin. CT r fn dN v I rl6 ©r c$dw �o ldl e, l w m <br /> m 1�c7 J` • 65r+8 c �? <br /> OWNER / a ti race- 0001 TELEPHONE <br /> AO <br /> / j� G r ' 5_617.1- <br /> EMERGENCY/FIRE <br /> per/ E <br /> ADDRESS a 3 15-V Q ' Q ��L Pj, �re AJ U's J GAO /.1- <br /> EMERGENCY/FIRE NUMBER 9315 ROAD NAME O�,K <br /> LEGAL DESCRIPTION (see t receipt)�� v <br /> v CSn') Uv f r� <br /> CONTRACTOR <br /> i <br /> TYPE OF PERMIT(S): DWEL ING/BUILDING GARAGE/ACCESSORY STRUCTURE Y ADDITION p <br /> SANITARY PRIVY <br /> /J FILLING/GRADING CAMPING UNIT o <br /> SUBDIVISION_ 0 <br /> STRUCTURE/ADDITION USE ( ��' wmA L(.PaL `F' Af- axtx-,, D2Li f'7 tk�,Q o 2 <br /> (Home/tabkVCommercial Business;Bedroom;Deck;etc.) Z T <br /> 0 0 <br /> 0 <br /> m <br /> a <br /> DIRECTIONS FOR PLOT 2LAN DRAWING: (Aerial or top view) <br /> 1. Show the location anc size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location oft ie well (Vi),septic tank (ST),and dralnfield (DF). I o <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the or Jinary high water mark of lake,stream, or river. <br /> 4. If separate plans are so bmitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 3 cn <br /> PLOT PLAN sur-% MAP o a <br /> o <br /> 1e—tt6ht 6'A' d6 e 1 <br /> S�•e �f f7-c-rtt�� sa, � tP-5/, fll <br /> L.Ia <br /> o More <br /> L-A be._ Si�� IY" I y <br /> See. )Oe��..f � y/ol FOrs <br /> S <br /> s <br /> C <br /> m <br /> o <br /> a <br /> I <br /> U�2 OULnyt��ro Uldl <br /> R,5 Ca i {k1 S• /�yJ)1 v� �'L4 I/ UC <br /> Lk)vl m V IriO I F vT <br /> � ( '1� b2 LrSos( �r 'ta^f'f Cf un4OHIt� RN I <br /> hh{(�rJJ (��(1J(]%__q� <br /> O 8r` C.QA)A,eLT7aw Or ^ WK � 13�/-Oe- 4;X0oz "`oM N N � o, r ➢ D p imE ' ' g � E t1SQ Wt-ta ga "_ 3 <br /> CONDITIONS OF PERMIT o Z. . C 0 0 > "< <br /> S2 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o <br /> 2. REMOVAL OR CUTTIN3 OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. .0 <br /> c n <br /> 3. NO GRADING OR SH RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> g <br /> 1 declare that this applicati n(including any accompanying schedule)has been examined by me and to the best of my knowl- o mi In <br /> edge and belief it is true,co rect and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- - � <br /> tion contained in this applii ation(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will a relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i $ 8 <br /> further accept all liability w flch 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 ounty officials charged with administering county ordinances or other authorized person to have O <br /> access to the above descri ed premises at any reasonable time for the purpose of inspection. 0 ! 8 <br /> m I . <br /> a <br /> SIGN HERE <br /> 43 <br /> (si t re of o r or building ! afte) �_ I V �' <br /> ZONING ADMINISTRATOR MAY II Imo- 8 E E E E <br /> TOWNSHIP PERMtAYBE hI�_WD ,! SEP 2 o 809 In <br /> - — ,I -- ---- - <br /> 899 988u <br />