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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS3_ <br /> 0 d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the so <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. H m <br /> OWNER ` )„ S(n2/� TELEPHONE Jr ? -7/.57t7o <br /> ADDRESS <br /> Kr.cJ /Yr.: (J�/✓ VM.Q� ""� <br /> U n q <br /> EMERGENCY/FIRE NUMBER a���� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) �eC L3 A LS^ TrlM (7)A, I p�SOh/ <br /> CONTRACTOR K6� j, )I . /I�/� L 1 J <br /> �r— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p 1 <br /> n L <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> R6 � ( /STRUCTURE/ADDITION USE: y0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 1 <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 drainflaid (DF). <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building -q <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 signed and — <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a w <br /> PLOT PLAN GG �/ a a <br /> PPL'Qhrr Fac (}Plzar�e �dd� hufPlitttt DI/,R RBST ¢ t/S laRlLf, vn fLtA2 m <br /> 7b R2K �fL f/Gzru A %r ae a eat cti dw�ouu - C�daac SGr/y7 C� <br /> � I <br /> �u cL 5�..�;Lep WrLL�� t (3-1924rr�- f Iq <br /> _ 103.5Z <br /> 6xu> ;y 0 <br /> 6[�s s <br /> I <br /> � , \)v r,411(l.ir-.. P,P`Sdi <br /> �( Aa�'h <br /> b it, T11, <br /> Ct� <br /> I � <br /> ( M <br /> foz.44 n' of m <br /> CONDITIONS OF PERMIT: — [/} m p Z C$ 3' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 �Q - - --1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o o 2i j mO <br /> o : o E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- «r y i+': m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i i B o ; p <br /> motion I am providing will be relied upon b the Count of Burnett Wisconsin in determining whether to issue a permit P g Pm Y Y g P E 0 0 <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 arged with administering county ordinances or other authorized person to have m m <br /> access to the above de ribed premises any reasonable time for the purpose of inspection. <br /> (D <br /> m m <br /> d N w <br /> SIGN HERE.//// <br /> ( ' not re of own building contractor) (date) 8 = <br /> o : s: <br /> ZONING ADMINISTRATOR : Q i r <br /> TOWNSHIP14ERMITS MAY BE REQUIRED 8 ( m <br /> m <br /> Co 0000000 f/1 <br />