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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Co m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m <br /> g by application for a Permit for the work descri and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la s and <br /> regulations of the State of Wisconsin. m° <br /> JJ '' ryry11'�\\II I1 / `' f! h fnla-a-�7- 7�i�r3 cc = o <br /> OWNER A/ll.N7� ChfIS`� fSC� TELEPHONE (v <br /> ADDRESS dQ^PP J t ) h is -� IJ I7� +CC--lr h 1 <br /> 1 <br /> EMERGENCY/FIRE NUMBER 3 ROAD NAME Cake �/-� Za� y- J� <br /> LEGAL DESCRIPTION (see tax receipt) L(7� b g'U CK. I ( �Uec epf %kt OUM, k I enS bf to lk <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING <br /> � t_ CAMPING UNIT SUBDIVISIONo <br /> QQ <br /> _ o _t <br /> STRUCTURE/ADDITION USE: Y }t%iT1,Q- I `�C6k ° �(}� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o a° <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 drainffeld (DF). <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. 0 r <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and 9 �u <br /> dated by the owner. C 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAID FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o to <br /> PLOT PLAN MaoUi( 'R, w i 1 molrc-lrl � c n� <br /> N bhSenenf Lut1?6x new4iCwt (W fillL N_I <br /> 0 <br /> � s <br /> � = <br /> S <br /> SI <br /> Ll <br /> t<>J �' �.- bldyyf`1ct{ 6t,trne d , Z <br /> T <br /> V�(3p Lak2 �� Wn-tO Selde- 9 c���M Tit <br /> CONDITIONS OF PERMIT: e < 33 <br /> �' Z. IFC S g2 i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F E IQ ` - =I2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - y' E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" p <br /> k : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- i o : E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation t am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 ` p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. ' ` e <br /> m <br /> a � w <br /> -'SIGN HERE XA'' �• w E [ <br /> (sign eturo ner or building contractor) <br /> ZONING ADMINIS TOR <br /> TOWNSHIP PE MITS MAY BE REQUIRED 1,� 5 $f f 15 m <br /> M <br /> ma'16c addigs .7 . ASLVad "10.7 ; _ $ 8$$ $$ 0 <br /> 3ti Oct(, ( Plij <br />