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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 D1 C � <br /> APPLICATION FOR — LAND USE — PERMITS <br /> Administrator m 3 f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m = o <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. 3 <br /> 0 <br /> _Tt m_ <br /> OWNER —..17-Q F� .I-/1 �t`.P A��C/j0 /4 J TELEPHONE �O <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ;174 7 3 <br /> ROAD NAME �.��pc <br /> LEGAL DESCRIPTION (see tax receipt) S M( 5L T C� <br /> S _ -,r61 a7 yQ/�R�KgY //74JCONTRACTOR 'b ` C �(/d y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING <br /> GARAGE/ACCESSORY STRUCTURE_ ADDITION s <br /> SANITARY PRIVY FILLING/GRADING �- <br /> C CAMPING UNIT SUBDIVISION 0 O <br /> o o �1 <br /> STRUCTURE/ADDITION USE �� o 1 <br /> m r w <br /> (Home/Cabin,Com...-M Bu mess, Bedroom, Deck;etc.) o <br /> Z , <br /> O O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I t° <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N)F). . <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (D 7 <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 /> 4. If teasurement to the ordinary l <br /> separate plansa a submitted an architect,t, engii eer,builder,,contractor,etc.,the plans must be signetl antl <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUSBE ISSUED. O O <br /> 0 <br /> T BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN 0 <br /> PLOT PLAN 71 <br /> Z o <br /> skQ�Q Al <br /> 1 3`IfOur <br /> R� <br /> O terry�'rto,.. p�Y'Ern.T • , �, T <br /> 4no be At <br /> ;N <br /> L. I <br /> J <br /> a <br /> VOM �o '6uCJ �� `f0 340 r 2 ~ <br /> � I <br /> I� <br /> 8 <br /> f� m17mr DDp <br /> CONDITIONS OF PERMIT: n ro a n u <br /> T DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z vZE <br /> dt n o M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. P F = Z <br /> I declare that this application(including any accompanying schedule)hasbeen examined by me and to the best of my knowl- $ ig m 9 C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this rma- <br /> mation I am providing will be relied u ` <br /> further accept all liability which may be <br /> result hof the County relyinnettWisconsg on n in determining <br /> information 1 am providing in this ap- B o G <br /> plication. l8 ree to permit. I o� o <br /> g Permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. » <br /> dram <br /> SIGN HERE <br /> (sign re owner or buil in contractoq <br /> ZONING ADMINISTRATOR <br /> U(+ 3 ! E E s E <br /> TOWNSHIP PERMITS MAY BE REQUIRE J 1 U 3 «+»w » <br /> u � « �» n <br /> ' '' O N INii Uri t!i N in <br /> ! <br /> 00000 0000 <br /> 0 0 m <br />