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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator in / C <br /> a E <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n W <br /> regulations of the State of Wisconsin. <br /> w v <br /> OWNER 'oApl'o L/ 'q/ <br /> TELEPHONE 'y39- 979Y w <br /> o <br /> ADDRESS l/A/ t;-5-OF !° <br /> EMERGENCY/FIR/E/NUMBER ROAD NAME 5+� T- / t <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Lat � csm , Usc. 1� 0 78' 79 i� Gou <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN UILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> ANITARV <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o = <br /> � w r <br /> STRUCTUR DDITION USE: a ;0 �!/l 7 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) �. S1W jjTf(2.0 o c <br /> � 3 <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). Q <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)building to center line of road,(c)building 11 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A P RMrl- CAN BE ISSUED. 11 a m <br /> c <br /> PLOT PLAN $�f f T L A M L ���p/f/�- o n <br /> py ' ea �Utik. sa 1� M U� o <br /> a L <br /> 4 �RA10 FItD 14a ' <br /> rrocc th�E 1cn <br /> 73 <br /> V' = <br /> CIG <br /> l <br /> 'As SAI <br /> O <br /> z <br /> V 68 , I x60 " <br /> � a/o <br /> .. T D m (n v fnr DD U <br /> - a <br /> g33 <br /> mmcN � 3 <br /> CONDITIONS OF PERMIT: o <br /> — —`'----- .� o J <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISS -- o F � E T� ' <br /> �-2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = a' m <br /> -----3 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED." : C <br /> 9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all inform fn m d+ 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor I ro N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit <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 county officials charged with administering county ordinances or other authorized person to have }O u p <br /> access to the above described premises at any reasonable time for the purpose of inspection. ro3 8 AN <br /> mA <br /> M U <br /> N N <br /> SIGN HEREoea <br /> (signature of ner o co r- date) s ' <br /> ZONING ADMINISTRATOR <br /> TOW HIP PERMITS MAY BE REQUIRED ] Q 1992 m <br /> 888 8888x, <br />