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JIMA <br /> &IF t ' <br /> Burnett County 7410 Co. Rd. K. No. 10Z Siren, WI SU72 Office of Zoning Administrator m m o 0 <br /> � <br /> APPLICATION FOR — LAND USE — PERMITS m 3 ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri d and v a <br /> located 88 shown herein. The undersigned agrees that all work shall be done in accordance with the requiremem of the $ <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. m <br /> OWNER TC O Q �.}-Q wtLL TELEPHONE / U 6_O� F <br /> 1 ` y ���JJJt Ki l✓v � o ° <br /> IMS ��I f,�� nl }/�p� I � �/ M m <br /> ADDRESS '115W I 1 1L1C-oarat. k I , hris--. -I.JI-V/'1�� Lft6i 111 <br /> EMERGENCY/FIRE NUMBER ] J ROAD NAME <br /> LEGAL DESCRIPTION (see tau receipt) U 1 U r <br /> Gni✓, Lot 1 Se; _ a S- Tw. Sl:o Nta <br /> CONTRACTOR <br /> TYPE OF PERMIT(S):•JDWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE /\ ADDITION o <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> m r- <br /> STRUCTURE/ADDITION USE: / O4.f Lsp,Q 0 0 <br /> (Home/Cabin;Comm rcial Business;Bedroom;beck;etc.) Z <br /> o ° <br /> 0 <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 Northi(N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (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 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 sig,led and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v N <br /> PLOT PLAN Z o a <br /> A n <br /> FF' W�.�C�lfrr� IA , <br /> fn <br /> CA, 6F 1 <br /> I) Sy'." 'tc, ry " <br /> o <br /> z) s-t, -it, be w5;J �., <br /> l ° <br /> �f l3d«,-f3 -f-t�a�7h�j m <br /> M Mo <br /> a <br /> I a <br /> e 9 ELr 2, g,e � <br /> CONDITIONS OF PERMIT: v 2,: Z CS g m r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. G Z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y i 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'i i O i m <br /> } g' ge ` C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- E «ro«? m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing yn this ap- ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have i 0: 0 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 <br /> v <br /> SIGN HERE «: <br /> (si ro f owner or building contractor) <br /> ZONING ADMINISTRATORJUL /(� E [ 8 E <br /> TOWNSHIP PERMITS MAY BE REQUIRED r V R S rn <br /> I� + o " N s' ' gg m <br /> ��'.�� $ 88888 $8 v, <br />