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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (n <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the '^ m <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. <br /> OWNER Ilt-2�4/,/I �l h�1/e iY1 Fnhi TELEPHONE 6,j S'" g y�� o <br /> // <br /> ADDRESS �[ �>�/ /� / <br /> C/1 11a Spoorre2 <br /> EMERGENCY/FIRE NUMBER / y 1// ROAD NAME <br /> LEGAL DESCRIPTION see tax recei t ! ]� ,�/ 7 �( <br /> ( P)�. rL¢�/vn• 3/e -M'�!-�� d1�K4.ys �u2�e eN �! khsd (/.xdneA4 <br /> CONTRACTOR <br /> ".J ,r. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> Q <br /> p m r <br /> — <br /> STRUCTURE/ADDITION USE: 64 44�cf-e_ �O x3 2_ o °— <br /> (Home/CabiCommercial Business;Bedroom; Deck;etc.) Z o <br /> 0 0 <br /> m <br /> D � <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 drainf laid (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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISS D. 1I v rn <br /> C <br /> PLOT PLAN «- - 5 o n <br /> m <br /> \ 20 m i <br /> A <br /> - <br /> +� (nlb <br /> 13 <br /> Z <br /> f pG �jr <br /> i <br /> d 5 o a f m <br /> '- < mzc:B � � T+ <br /> CONDITIONS-O`F PERMIT: G`� "\ <br /> t-BRtVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE <br /> o 'z 'H <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Co: ' 31 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ^ 1 0 ; � O <br /> YJ p : n� 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- i .0 <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- «' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I 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 1 am providing in this ap- <br /> plication.I agree to 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. b <br /> MY <br /> i <br /> SIGN HE <br /> (a' a re of owner or wilding contractor) (date) o �• <br /> ZONING ADMINISTRATOR <br /> �� y+N N 4 N N N y m <br /> 7 TOWNSHIP PERMITS MAY BE REOUIRED .8 u, P, v, �n M O fn <br /> 000000000 <br />