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Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54072 Office of Zoning Admir Istrator 00 9 i Z <br /> APPLICATION FOR — LAND USE — PERMITS E <br /> lobated as Shown herein. The undersigned agrees that all work shall be <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ibed and <br /> done in accordance with the requiof the <br /> a , <br /> o O� <br /> rem nts laws and m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the la --� <br /> regulations of the State of Wisconsin. - F J <br /> OWNER SC�IyN �=✓ylvl i2K r-rm 2-T...&ICELEPHONE (old. dig �I-�'�O y n m O <br /> ADDRESS 1 ?JC.I� b SUNS` LF-�_ t�2. 13v2n.5Vtu.i' 141/-1 563 �- <br /> EMERGENCY/FIRE NUMBER N&W (..b T ROAD NAME L I <br /> LEGAL DESCRIPTION (see tex receipt) ?b� 2M ` c9(.. <br /> 1 f I b ` .z ht r, r'i n+T VV <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING- GARAGE/ACCESSORY STRUCTURE X _ ADDITION v <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo <br /> o <br /> i H � <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial usiness; Bedroom;Deck;etc.) Z <br /> o ° <br /> v <br /> m <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 drainfleid (DF). 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 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 all ned and <br /> 9-1 <br /> dated by the owner. O 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE S AKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BESUED. an v y <br /> PLOT PLAN / o a <br /> / P 0� o <br /> <C, <br /> �� 63 <br /> 2,1 4f <br /> Ao 11 Q m <br /> r _ <br /> N� 9y�q N T <br /> U � <br /> z <br /> r <br /> r <br /> Ir <br /> i <br /> b.H.wly A �H���g¢1m <br /> CONDITIONS OF ER L(.Rwr i%(,UWHIrI� o m g C g <br /> 1. DRI RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z in '' 8'Z <br /> OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° F ' ` '-1 U <br /> 33 <br /> 3. NO D ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. NqG <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ` 0 E C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all'nforma- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a oermit. I ✓k <br /> further accept all liability which ay be a result of the County of Burnett relying on this information I am providing i this ap- <br /> plication.I agree to permit cou officials charged ith administering county ordinances or other authorized person to have <br /> access to the above descri rami s at any re onable time for the purpose of inspection. <br /> SIGN HERE q 1,\ ! -filli14Y <br /> (Sig u o ner or bu 1 1 p tractoq � ; ---(date) <br /> ZONING AD NIS ATOR MAY8 ; <br /> TOW IP PERMITS MAY BE REQUIRED �'" �'" " <br /> NU5 ma <br /> 8888�8� i <br /> ��7 � o�T <br />